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How-to-do-it

Towards no-scar cardiac surgery — minimally invasive access through umbilicus for aortic valve replacement

Department of Cardio-Vascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, BH10-275, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland

Received 26 January 2009; received in revised form 15 June 2009; accepted 18 June 2009.

^_* Corresponding author. Current address: Center of Cardiac Surgery, Pauls Stradins Clinical University Hospital, Pilsonu str. 13, Riga, LV-1002, Latvia. Tel.: +371 6 7069221; fax: +371 6 7069421. (Email: martins.kalejs{at}stradini.lv).

There is an ever-growing trend towards less-invasive procedures in all fields of medicine. We designed an animal study to prove the concept that trans-apical aortic valve replacement from an incision within the umbilicus through a single channel for instruments is feasible, which would be a major leap towards no-scar cardiac surgery. In three adult pigs, after creating a single 3-cm incision at a place where the human umbilicus would be, we introduced a 30F sheath through a tunnel created by an endoscopic vein-harvesting device up to the cardiac apex, through it and up to the left ventricle simulating the approach for trans-apical aortic valve replacement. We used a standard Amplatz nitinol occluder to seal the defect in ventricle wall later. The animals were followed up for 1 h. Blood loss was minimal, and no tamponade occurred in any of the animals. In addition, we performed a test with water column static pressure to evaluate the impact of preclotting on the sealing properties of the occluders: 1 min flow-through was 2860 ± 176 ml for the standard occluders and 348 ± 56 ml for preclotted occluders (p < 0.001).

Key Words: Minimally invasive cardiac surgery • No-scar surgery • Trans-catheter valve replacement • Occluder • Trans-apical access

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				B. Marty and B. Egger Editorial comment: Access to the heart by a trans-umbilical incision Eur. J. Cardiothorac. Surg., October 1, 2009; 36(4): 775 - 775. [Full Text] [PDF]