Anesthesia for Minimal Invasive Cardiac Surgery: The Bonn Heart Center Protocol.

The development and adoption of minimally invasive techniques has revolutionized various surgical disciplines and has also been introduced into cardiac surgery, offering patients less invasive options with reduced trauma and faster recovery time compared to traditional open-heart procedures with sternotomy. This article provides a comprehensive overview of the anesthesiologic management for minimally invasive cardiac surgery (MICS), focusing on preoperative assessment, intraoperative anesthesia techniques, and postoperative care protocols. Anesthesia induction and airway management strategies are tailored to each patient's needs, with meticulous attention to maintaining hemodynamic stability and ensuring adequate ventilation.

Comparison of Two Surgical Approaches for Coronary Artery Bypass of Left Anterior Descending Artery.

: The minimally invasive approach through left mini-thoracotomy is a promising alternative to the median sternotomy for coronary artery bypass. The aim of this study was to compare the short-term outcomes of patients undergoing minimally invasive coronary artery bypass (MIDCAB) with off-pump coronary artery bypass through sternotomy (OPCAB) for single-vessel disease. : From January 2017 to February 2023, 377 consecutive patients aged above 18 years undergoing off-pump bypass of the left anterior descending artery (LAD) with left internal thoracic artery underwent OPCAB.

Short-Term Clinical Results of Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Procedure.

Minimally invasive direct coronary artery bypass (MIDCAB) is an alternative for revascularisation of the isolated left anterior descending (LAD) artery or as a multi-vessel (MV) procedure for the diagonal branch (RD) or the left circumflex coronary artery (LCX) region. From 2021 to 2022, 91 patients underwent MIDCAB or multi-vessel MIDCAB procedures in our heart center. The left internal mammary artery (LIMA) was anastomosed to the left anterior descending artery via the left minithoracotomy approach in all patients.

Postoperative results of minimally invasive direct coronary artery bypass procedure in 234 patients.

Introduction: Minimally invasive approach in cardiac surgery has gained popularity. In order to reduce surgical trauma in coronary surgery minimally invasive direct coronary artery bypass (MIDCAB) has already been established. This technique has been introduced for revascularisation of isolated left anterior descending (LAD).

Right minithoracotomy and resternotomy approach in patients undergoing a redo mitral valve procedure.

Objectives: A minimally invasive approach via a thoracotomy is an alternative in challenging redo cardiac procedures. Our goal was to present our early postoperative experience with minimally invasive cardiac surgery via a right minithoracotomy (minimally invasive) and resternotomy in patients undergoing a mitral valve procedure as a reoperation.

Methods: From 2017 until 2020, reoperation of the mitral valve was performed through a right-sided minithoracotomy in 27 patients and via a resternotomy in 26 patients.

A novel approach for quantification of the future unmet medical need in right ventricular dysfunction.

Although 'unmet medical need' (UMN) is an increasingly used term in the healthcare sector instrumental to the approximate value of drug discovery projects relevant to portfolio management, no standardized approach exists for its quantification. Especially in diseases with different comorbidities, high patient heterogeneity, and incomplete epidemiological data, it is difficult to judge the need for new therapies. The approach presented here combines an expert assessment of key UMN indicators related to the individual patient with a literature search to collect epidemiological data describing the corresponding patient population with its underlying heterogeneity.

Longer-term outcomes after bicuspid aortic valve repair in 142 patients.

Background: The aim of this study was to evaluate the longer-term results of bicuspid aortic valve (BAV) repair with or without aortic root replacement.

Methods: From 1999 to 2017, 142 patients with or without aortic root dilatation who underwent repair of a regurgitant BAV were included in the study. Ninety-four patients underwent isolated BAV repair (Group 1; median age 43 years) and 48 patients underwent valve-sparing aortic root replacement plus BAV repair (aortic valve reimplantation-Group 2; median age 48 years).

Cardiac metastasis causes paradoxical malignant embolism.

Background: Embolic events play an important role in clinical everyday practice. Malignant arterial embolism is a rare nevertheless often fatal entity for cardiac, cerebral or systemic ischemia, requiring immediate diagnosis and treatment.

Case: This is a case report of a 65 years-old female, suffering from pulmonal adenocarcinoma, who was hospitalized due to neurological deficits caused by an acute ischemic stroke, followed by anterior myocardial infarction within 3 days.

First Experiences with MANTA Vascular Closure Device in Minimally Invasive Valve Surgery.

Background:  To more minimize the minimally invasive valve surgeries, percutaneous vascular access and closure has been used for the establishment of extracorporeal circulation. This study investigates early clinical outcomes of patients who received MANTA for femoral artery closure as first experiences in minimally invasive valve surgery.

Methods:  Between January 2019 and July 2019, 103 consecutive patients (mean age: 58 ± 11 years) underwent video-assisted minimally invasive valve surgery through right anterior minithoracotomy at two cardiac surgery referral centers in Germany.

Right mini-thoracotomy approach in patients undergoing redo mitral valve procedure.

Aim: A minimally invasive technique is an attractive option in cardiac surgery. In this study, we present our experience with minimally invasive cardiac surgery (MICS) via right mini-thoracotomy on patients undergoing mitral valve procedure as reoperation.

Methods: From 2017 until 2019, 20 patients underwent reoperation of the mitral valve through a right-sided mini-thoracotomy.

Outcome of surgery for acute infective endocarditis: does preoperative stroke have an impact on mortality?

Purpose: Surgical therapy of infective endocarditis (IE) is challenging and can be associated with high mortality. In this study, we present the early outcomes of patients who underwent cardiac surgery for IE.

Methods: From 2017 until 2019, 66 patients underwent surgical treatment for IE.

Aortic Valve Repair for Aortic Insufficiency or Dilatation: Technical Evolution and Long-term Outcomes.

Background: Aortic valve repair (AVR) is an attractive alternative to valve replacement for the treatment of aortic valve insufficiency. Here we report on the midterm outcomes after AVR for aortic valve insufficiency with an emphasis on durability of repair.

Methods: Between 1996 and 2017, 560 consecutive patients (mean age, 57 ± 16 years) underwent various AVR procedures on tricuspid (n = 415, 74%) and bicuspid (n = 145, 26%) aortic valves.

Efficacy and safety of transvenous lead extraction in 108 consecutive patients: a single-centre experience.

Objectives: The number of cardiac implantable electronic devices is growing worldwide because they play a relevant role in improving the survival rate in patients with specific heart diseases. Cardiac implantable electronic devices complications including infection, dysfunction or venous stenosis increase the need for the least traumatic way to explant leads. Our goal was to report the successes and procedural complication rates of transvenous lead extraction (TLE) in a consecutive series of patients.

Mid-Term Clinical Outcome of Patients Undergoing Coronary Artery Bypass Grafting with Valvulotomized Vein Grafts.

Background: The lower patency rate of vein grafts (VG) in comparison to arterial grafts may be related to vein valves, which favor turbulences and thrombosis that lead to graft failure. The aim of this study was to determine the outcome of patients with valvulotomized VG after coronary artery bypass grafting (CABG) procedure.

Methods: From 2007 to 2014, 233 patients with a mean age of 67 ± 9 years had CABG or combined CABG and valve procedures.

Propensity-matched comparison between minimally invasive and conventional sternotomy in aortic valve resuspension.

Objectives: The aim of the study was to compare the results of David procedure through conventional or minimally invasive approach.

Methods: A propensity-matched comparison in patients undergoing a minimally invasive (partial upper sternotomy, n = 103) or complete sternotomy (n = 103) David procedure from 1991 to 2016 was performed. Patients were 57 ± 14 years old on average in both groups.

Minimally invasive aortic arch surgery: Early and late outcomes.

Background: We analyzed our experience with the aortic arch operations performed through a minimally invasive approach, with emphasis on safety and feasibility, early and late outcomes.

Material And Methods: We reviewed the medical records of 71 adult patients with aortic arch aneurysm (58, 82%), dissection (10, 14%) or porcelain aorta (3, 4%) who underwent primary arch surgery through a partial upper sternotomy.

Results: The aortic arch was replaced partially in 45 (63%), or totally in 26 (37%) patients.

Midterm Results of a Minimally Invasive Approach in David Procedure.

Background: The David procedure is a well-known technique in selected patients with aortic root pathology. A minimally invasive approach in heart surgery increases open interest.

Methods: From 1991 to 2015, the David technique was performed in 296 patients in our unit.

Triple valve surgery through a less invasive approach: early and mid-term results.

Objectives: A partial upper sternotomy has become established as a less invasive approach mainly for single and double valve surgery. This report evaluates the clinical outcomes of triple valve surgery performed through a partial upper sternotomy.

Methods: We reviewed the medical records of 37 consecutive patients (28 men, 76%) who underwent triple valve surgery through a partial upper sternotomy between 2005 and 2015.

Long-Term Results Following Pericardial Patch Augmentation for Incompetent Bicuspid Aortic Valves: A Single Center Experience.

Background: Many techniques for repair of bicuspid aortic valves have been described and long-term results differ considerably. The current study evaluates our institutional results using the pericardial patch augmentation technique with the aim of increasing coaptation height.

Methods: From November 2002 through April 2015, 103 consecutive patients underwent aortic valve repair using pericardial patch augmentation for incompetent bicuspid aortic valve.

Can Perioperative Right Ventricular Support Prevent Postoperative Right Heart Failure in Patients With Biventricular Dysfunction Undergoing Left Ventricular Assist Device Implantation?

Objectives: Depending on the pre-existing condition of the right ventricle (RV), left ventricular assist device (LVAD) implantation may have a detrimental effect on RV function, subsequently leading to right heart failure. This study details the authors' experience with perioperative mechanical RV support in patients with biventricular impairment but primarily scheduled for isolated LVAD implantation.

Design: Retrospective study.

Long-term results of the David Procedure in patients with acute type A aortic dissection.

Introduction: The David Procedure may provide an attractive alternative to aortic root replacement in patients with aortic valve insufficiency (AI) even in the emergency setting of an acute type A aortic dissection (AAD).

Methods: From 1996 to 2011 the David Procedure was performed in 23 patients with AAD in our department. Patients' mean age was 49 ± 15 years and 70% (n = 16) were male.

One-Year Patency of Valvulotomized Vein Grafts Is Similar to That of Arterial Grafts.

Background:  Inferior vein graft patency after coronary artery bypass grafting (CABG) is attributed to various factors. Venous valves may limit flow, cause thrombus formation, and diminish diastolic backflow. The aim of our study was to compare clinical outcome and midterm patency rate of valvulotomized vein grafts and arterial grafts in patients undergoing CABG.

A 17-year, single-centre experience with the Ross procedure: fulfilling the promise of a durable option without anticoagulation?

Objectives: For adult patients <60 years with aortic valve disease, the Ross procedure is an attractive alternative to a prosthetic aortic valve. The Ross procedure enables surgeons to achieve a haemodynamically ideal aortic valve replacement. A potential drawback may be long-term durability, which varies considerably between series.

Hematologic Effects of Heart Valve Prostheses and Vascular Grafts after Aortic Root Replacement.

Background: Heart valve prosthesis as well as vascular grafts cause changes in blood parameters. This may correlate with valve-related complications, less frequently observed after repair surgery. We thus studied changes in rheology after Bentall, Ross, or Tirone David (TD) procedure.