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Challenges in cardiac surgery
The purpose of this presentation is to discuss two areas of cardiac surgery
that have developed rapidly over the last few years. The first area of interest
is minimally invasive surgery for aortic valve disease. The second is a
discussion of the advantages of off-pump, or beating heart, surgery and a look
at how this is performed.
At the end of this session, one should be able to identify the advantages of
minimally invasive aortic valve surgery and explain the differences in minimally
invasive surgery versus the conventional approach. The other objective is to
identify the risks and benefits of off-pump, or beating heart, surgery.
Minimally invasive aortic valve surgery
Recent advances in minimally invasive surgery have allowed us to perform
valve surgery with a smaller incision. Advantages for patients include less
surgical trauma, earlier recovery of activity and a lower requirement for blood
transfusion. The actual valve replacement is done with conventional techniques
just through a smaller sternal portal. Cardiopulmonary bypass is required for
all valve surgery, but new techniques such as vacuum assistant venous drainage
have allowed for smaller cannulae (blood tubes) and a clearer field during the
operation.
Off-pump (beating heart) surgery
Recent advances in mechanical techniques for stabilizing the heart as it
beats have allowed surgeons to do coronary artery bypass surgery without the use
of cardiopulmonary bypass. This is known as off-pump, or beating heart, surgery.
There are several stabilizers available commercially which immobilize the heart
at the point of coronary artery anastomosis. This allows the surgeon to do the
grafting with an immobilized heart while the heart beats around the fulcrum of
the stabilizer. The advantages of avoiding cardiopulmonary bypass for coronary
artery surgery include, the decrease in the inflammatory response, decrease in
postoperative bleeding and improved organ function. Disadvantages include the
difficulty in performing anastomosis in areas of the heart that are hard to
access while the heart continues to beat.
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