Surgery without Scars: Right Lateral Access for Minimally Invasive Aortic Valve Replacement.

As part of an institutionally driven holistic concept, named the "360-degree approach," all established surgical access routes -full sternotomy, partial upper sternotomy, and right anterolateral thoracotomy using the second interspace-are supported. The surgical toolbox now is completed by adding a further approach: through a 5- to7-cm skin incision in the right anterior axillary line, the third interspace is used for a minimally invasive aortic valve surgery providing striking exposition of the aortic valve and resulting in superior cosmetics with nearly no visible scars. The choice for the one or other method is institutionally driven and based on risk profiles, as well as anatomical and physiognomic considerations.

Omega-3 polyunsaturated Fatty acids reduce the incidence of postoperative atrial fibrillation in patients with history of prior myocardial infarction undergoing isolated coronary artery bypass grafting.

INTRODUCTION: The impact of omega-3 polyunsaturated fatty acids (PUFAs) for prevention of atrial fibrillation (AF) is still part of a lively debate. The present study evaluates the impact of orally administered omega-3 ethyl ester concentrate (omega-3 PUFA) on postoperative onset of AF in patients with recent myocardial infarction (≤ 3 months) undergoing isolated coronary artery bypass grafting (CABG). Patients and METHODS: The study included a total of 198 patients with recent (≤ 3 months) myocardial infarction. The treatment group consisted of 99 prospectively and randomly assigned patients. A matched control group was generated out of the entirety of patients undergoing isolated CABG during the same time period, being not treated with omega-3 PUFA. Primary endpoint was onset of postoperative AF. Patients of the treatment group received a daily dose of 2 g omega-3 PUFA, initiated 5 days before surgery. Effective serum levels were confirmed by laboratory testing. RESULTS: Patients of the treatment group had less frequently postoperative AF (treatment: 31.3% vs. control: 48.0%; p = 0.017). The reduction in relative risk was 34.8% in the treatment group, which conforms a number needed to treat (NNT) of 6.0 patients. A more pronounced effect with a NNT of 4.1 was observed in patients ≤ 70 years (p = 0.007). Besides, patients of the treatment group had a shorter intensive care unit stay (p = 0.001) and suffered less frequently from impaired wound healing by trend (p = 0.063). One patient out of treatment group and two out of control group died during hospital stay (p = 1.000). CONCLUSION: Preoperative administration of 2 g omega-3 PUFA reduces incidence of postoperative AF in patients with recent (≤ 3 months) myocardial infarction undergoing isolated CABG.