Experiência inicial com operações cardíacas minimamente invasivas / Initial experience with minimally invasive cardiac operations

INTRODUÇÃO: Operações cardíacas minimamente invasivas têm sido propostas como uma alternativa para a correção de diversas cardiopatias congênitas e adquiridas, com o intuito de reduzir a morbimortalidade. OBJETIVOS: Descrever a experiência inicial de dois anos com operações cardíacas minimamente invasivas, com ênfase nos aspectos técnicos e na curva de aprendizado. MÉTODOS: Entre julho de 2009 a março de 2012, 95 pacientes foram operados com técnicas minimamente invasivas. A média de idade foi de 55±15 anos e 53% pacientes eram do sexo feminino. As operações foram fechamento de comunicação interatrial (25), substituição valvar aórtica (32), plastia mitral (23), substituição valvar mitral (12), ressecção de mixoma de átrio esquerdo (2) e ressecção de membrana subaórtica (1). A incisão consistiu de minitoracotomia lateral direita em 87 casos e de miniesternotomia em oito. RESULTADOS: A mortalidade imediata foi de 4,2%, e o tamanho médio da incisão foi de 6,3 ± 1,2 cm. A extensão da toracotomia só foi necessária em um caso. Dois pacientes apresentaram acidente vascular cerebral, e a quantidade total de sangramento foi de 470 ± 277 ml. Nenhum paciente teve infecção de ferida operatória, e 67% dos casos não apresentaram morbidade pós-operatória significativa. CONCLUSÕES: Os resultados iniciais com operações minimamente invasivas demonstraram que elas podem ser realizadas de forma segura e com resultados iniciais satisfatórios. O índice de satisfação dos pacientes foi elevado. Uma vez ultrapassada a curva de aprendizado, as operações minimamente invasivas podem ser uma excelente alternativa para muitos pacientes com cardiopatias valvares e congênitas.

BACKGROUND: Minimally invasive cardiovascular operations have been proposed as an alternative method to correct several cardiac congenital and acquired heart diseases, with the aim to reduce morbidity and mortality. OBJECTIVES: Describe the two years initial experience with minimally invasive operations, with emphasis on technical aspects and the learning curve. METHODS: Between July 2009 and March 2012, 95 patients were operated using minimally invasive operations. Mean age was 55 ± 15 years and 53% were females. The operations performed were atrial septal defect closure (25), aortic valve replacement (32), mitral valve repair (23), mitral valve replacement (12), excision of atrial myxoma (2) and resection of subaortic membrane (1). The incision was a mini right thoracotomy in 87 cases and ministernotomy in 8. RESULTS: Early mortality was 4.2%. Mean size of the incision was 6.3 ±1.2 cm. Extension of the original thoracotomy was necessary in only one case. Two patients suffered a stroke, and the mean total blood loss was 470 ± 277 ml. There were no cases of incision infection and 67% the patients had no major morbidity. CONCLUSIONS: Our initial results with minimally invasive operations demonstrated that it was safe and with good clinical results. Patient satisfaction is quite high. After the learning phase has been transversed, minimally invasive operations may be an excellent alternative for many patients with congenital and acquired diseases.

Initial experience with minimally invasive cardiac operations.

BACKGROUND: Minimally invasive cardiovascular operations have been proposed as an alternative method to correct several cardiac congenital and acquired heart diseases, with the aim to reduce morbidity and mortality. OBJECTIVES: Describe the two years initial experience with minimally invasive operations, with emphasis on technical aspects and the learning curve. METHODS: Between July 2009 and March 2012, 95 patients were operated using minimally invasive operations. Mean age was 55 ± 15 years and 53% were females. The operations performed were atrial septal defect closure (25), aortic valve replacement (32), mitral valve repair (23), mitral valve replacement (12), excision of atrial myxoma (2) and resection of subaortic membrane (1). The incision was a mini right thoracotomy in 87 cases and ministernotomy in 8. RESULTS: Early mortality was 4.2%. Mean size of the incision was 6.3 ±1.2 cm. Extension of the original thoracotomy was necessary in only one case. Two patients suffered a stroke, and the mean total blood loss was 470 ± 277 ml. There were no cases of incision infection and 67% the patients had no major morbidity. CONCLUSIONS: Our initial results with minimally invasive operations demonstrated that it was safe and with good clinical results. Patient satisfaction is quite high. After the learning phase has been transversed, minimally invasive operations may be an excellent alternative for many patients with congenital and acquired diseases.