Robinson Poffo

Video-assisted cardiac surgery: results from a pioneer project in Brazil

OBJECTIVE To demonstrate the possibilities of the use of videothoracoscopy in cardiac surgery using cardiopulmonary bypass (CPB). METHODS Between February 2006 and November 2008, 102 patients underwent consecutively minimally invasive video-assisted cardiac surgery. The cardiac pathologies approached were: mitral valvopathy (n=56), aortic (n=14), interatrial communication (IC) (n=32), six patients presented associated tricuspid insufficiency and 12 presented atrial fibrillation. The age ranged from 18 to 68 years and 57 were female. The surgical approach was: femoral arterial and venous cannulation, minithoracotomy ranging from four to six centimeters (cm) at the level of the 3 degrees or 4 degrees right intercostal space (RICS), depending on the pathology of the patient, between anterior axillary line and hemiclavicular line, submammary or right periareolar groove through the right breast and thoracoscopy. RESULTS The surgical procedures were: plasty (n=20) or mitral valve replacement (n=36), aortic valve replacement (n=14), atrioseptoplasty using pericardial patch (n=32), tricuspid valve repair with rigid ring (n=6) and surgical correction of atrial fibrillation with radiofrequency (n=12). There were no complications during the procedures. There was no conversion to thoracotomy in neither case. Two patients developed atrial fibrillation in the postoperative period. There was an episode of stroke seven days after the hospital discharge and one death (0.9%) due to systemic inflammatory response syndrome (SIRS). CONCLUSION This study demonstrates the coverage of pathologies that are possible to be approached by video-assisted cardiac surgery with cardiopulmonary bypass being a safe and effective procedure with low morbimortality. Minimally invasive video-assisted cardiac surgery is already a reality in Brazil, demonstrating excellent aesthetic and functional results.

Video-assisted minimally invasive mitral valve repair: periareolar approach

Trabalho realizado no Hospital Israelita Albert Einstein – Sao Paulo– SP e no Hospital Hans Dieter Schmidt – Joinville – SC1. Coordenador do Programa de Cirurgia Cardiaca MinimamenteInvasiva do Hospital Israelita Albert Einstein – Sao Paulo – SP.Coordenador do Servico de Cirurgia Cardiaca do Hospital HansDieter Schmidt – Joinville – SC.Mestre em Clinica Cirurgica pela Universidade Federal do Parana.

Troca valvar mitral minimamente invasiva videoassistida

The use of minimally invasive technics in cardiac surgery has become widely discussed, aiming improvements not only in the aesthetics aspects but also better functional results. In this report, we present a case of a patient with severe mitral stenosis that underwent successful video-assisted minimally invasive mitral valve replacement.

Cirurgia robótica em Cardiologia: um procedimento seguro e efetivo

OBJECTIVE: To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery. METHODS: From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy. RESULTS: The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days. CONCLUSION: Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies.ABSTRACT Objective: To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery. Methods: From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy. Results: The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days. Conclusion: Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies.

Minimally invasive video-assisted atrial septal defect correction and myocardial revascularization

CARACTERIZACAO DO PACIENTEPaciente do sexo masculino, 42 anos, caucasiano epesando 92 kg. A historia clinica referia desconfortoretroesternal e fadiga aos medios esforcos. Como historiamorbida pregressa, havia sido submetido a angioplastiacom stent nao farmacologico do ramo interventricularanterior (RIA) ha um ano, em decorrencia de angina estavel.Negava qualquer outro problema associado e estava emuso de aspirina e betabloqueador. Ao exame fisicoapresentava-se corado, eupneico e sem queixas. A ausculta,os campos pleuro-pulmonares encontravam-se livres e aausculta cardiaca o ritmo era sinusal, com desdobramentofixo de segunda bulha.A radiografia de torax mostrava area cardiaca aumentadaa custa do ventriculo direito (VD). O ecocardiogramademonstrou dimensao do atrio esquerdo (AE) normal (4,0cm) e ventriculo esquerdo (VE) com diâmetro cavitarionormal (diâmetro sistolico de VE: 2,70 cm – diâmetrodiastolico de VE: 5,0 cm) e espessura miocardica normal. OVD encontrava-se aumentado (diâmetro diastolico de VD:4,10 cm) e a arteria pulmonar levemente dilatada (2,6 cm). Afracao de ejecao foi estimada em 77%. A valva tricuspideapresentava refluxo funcional e a pressao da arteriapulmonar foi estimada em 40 mmHg. Notou-se alteracao nosepto interatrial devido a presenca de comunicacaointeratrial (CIA) tipo

Robotic assisted minimally invasive surgery for atrial septal defect correction

1. Master in Surgery from the Federal University of Parana,Coordinator of the Center for Minimally Invasive Cardiac Surgeryand Robotics of the Albert Einstein Hospital, Sao Paulo, SP,Brazil.2. Cardiovascular Surgeon at the Center for Minimally InvasiveRobotic Cardiac Surgery, Albert Einstein Hospital, Sao Paulo, SP,Brazil.3. Cardiovascular Surgeon at Albert Einstein Hospital, Sao Paulo,SP, Brazil, and Hans Dieter Schmidt Hospital, Joinville, SC, Brazil.

Periareolar Access for Minimally Invasive Cardiac Surgery: The Brazilian Technique

The periareolar access has been the preferred technique used at our institution for minimally invasive cardiac surgery since 2006. The surgical approach consists of video-assisted minithoracotomy in the 4th right intercostal space, through a periareolar incision. Initially, the technique was restricted to minimally invasive mitral valve surgeries but, due to its feasibility and safety, was soon incorporated as an ideal access for other cardiac pathologies such as tricuspid valve disease, atrial septal defect, atrial fibrillation, and pacemaker leads endocarditis. The technique was performed in 214 patients, and it is associated with excellent aesthetic and functional results, with low morbimortality and no reoperations at long-term follow-up. Here, we describe and support the use of periareolar access as a routine surgical technique for correction of several cardiac pathologies, especially in women.