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Eur J Cardiothorac Surg 1998;14:S1-S2
© 1998 Elsevier Science NL

World Congress of Minimally Invasive Cardiac Surgery: Overview of Proceedings

^a CCN, St Denis, France
^b Columbia Hospital at Medical City, Dallas, Texas, USA

^* Corresponding author. Service de Chirurgie Cardiovasculaire, CCN (Centre Cardiologique du Nord) 32 rue de Moulins Gémeaux, 93207 St. Denis, France. Fax: +33 1 47334143; E-mail: natafpat@worldnet.fr

Since the 1995 introduction of minimally invasive cardiac surgery into clinical practice, there has been widespread enthusiasm, intellectual curiosity and healthy skepticism regarding the techniques and applications. Due to the relatively short life span of these procedures, accurate information regarding appropriate indications, patient selection, operative technique and results has been incomplete or lacking.

The first World Congress on Minimally Invasive Cardiac Surgery met in Paris, France on May 30th and 31th, 1997. The Congress was organized by La Pitié Hospital, Paris and Columbia Hospital Medical City, Dallas. The meeting was jointly sponsored by the Duke University Medical Center and La Pitié Hospital. Iradj Gandjbakhch and Alain Pavie joined the authors on the organizing committee.

The meeting was organized to serve as a platform to discuss the aforementioned issues as well as to introduce new innovations and techniques to the participants of the Congress. It was our pleasure to serve as program directors for this Congress.

The meeting was attended by over 600 surgeons from over 30 countries on six continents. In addition, representatives from 27 industry sponsors that serve the minimally invasive cardiac surgery field attended and participated in the meeting.

The program featured invited presentations from 15 invited faculty members regarding topics of broad interest in the field of minimally invasive cardiac surgery. In addition, 40 scored abstracts from over 120 abstracts submitted were presented. These free-paper presentations served to highlight the rapid adoption and ingenious innovations that are occurring worldwide in minimally invasive cardiac surgery. The innovative techniques, as well as ingenious thinking and unexpectedly large experience, made these sessions the most stimulating part of the meeting.

The summary of presentations presented in this issue of the Journal serve as a narrative of these proceedings. It is difficult to give an overview and make generalizations regarding topics that are so new, controversial and diverse.

At the risk of making overly broad generalizations and representations of the proceedings, the program directors submit this summary of the highlights of the first Congress.

• Results of the all minimally invasive cardiac surgery are presently short-term to intermediate-term. Definitive conclusions regarding applications and outcomes are therefore impossible. However, the procedures are very rapidly finding their role in minimally invasive cardiac surgery; strict indications are still yet to be defined.

• Minimally invasive coronary artery surgery appears to currently be approximately 80% beating heart surgery and 20% Port Access surgery.

• All minimally invasive coronary surgery appears to be limited for the most part to single-vessel disease on the anterior surface of the heart. Although limited experience with multivessel revascularization by both beating heart and Port Access techniques exists, it represents less than 10% of the total experience at the present time.

• Results of beating heart minimally invasive coronary artery bypass are beginning to appear to approach acceptable graft patency. Target vessel stabilization appears to be a sine qua non of beating heart surgery. Results are being divided into the `prestabilization' and `stabilizalion' eras with results appearing to be superior when stabilization is used.

• Professor Calafiore presented mid-term results of minimally invasive beating heart coronary artery bypass that gave some indication of expected results. Many innovative techniques for minimally invasive valve surgery were presented. These include multiple variations of partial sternotomies from upper `inverted T' incisions to `J' incisions to both the right and left as well as vertical parasternal and right anterior thoracotomy incisions for both aortic and mitral valve procedures. Although many innovative approaches were described, demonstration of definitive benefit is going to be very difficult.

• Numerous complications of minimally invasive cardiac surgery were reported including concerns about graft patency for beating heart surgery and aortic dissection with retrograde femoral techniques. An incidence of aortic dissection of around 2% with retrograde femoral cannulation and endo-aortic occlusion techniqes was reported.

• Extensive experience with transmyocardial laser revascularization (TMR) was presented. Although experience has broadened and technique of performing this procedure by minimally invasive techniques was presented, definitive evidence of benefit as well as mechanism of benefit are still not clear.

• It appears as if minimally invasive cardiac surgery will make a lasting contribution to the field of cardiac surgery. It, however, will be a `niche' procedure that has limited application in limited disease and will more gradually increase its application in future years.

• Numerous ingenious techniques for harvesting the internal mammary artery were described. Thoracoscopic techniques for harvesting the internal mammary artery are gradually becoming more generally applicable.

• Numerous techniques for the assessment of graft patency were also described, but angiography currently remains the gold standard.

• Numerous ingenious applications of minimally invasive techniques in the field of congenital heart surgery were presented including an extensive experience with patent ductus arteriosus (PDA) ligation, the division of vascular rings, as well as a rapidly increasing experience in intracardiac procedures including atrial septal defect repair.

• Extensive discussions regarding the role of hybrid procedures in which minimally invasive cardiac surgery is combined with catheter procedures as well as the use of robotics in minimally invasive coronary surgery served to further stimulate future applications.

Another important event at the Congress was the formation of the International Society for Minimally Invasive Cardiac Surgery (ISMICS). The organization was formed with Robert Emery of Minneapolis being elected its first President. The President Elect is Patrick Nataf. The Second World Congress on Minimally Invasive Cardiac Surgery will take place in Minneapolis, Minnesota in June, 1998 with the Third World Congress being held again in Paris in the Spring, 1999.

We were pleased to be able to serve as program directors for this First Congress and we feel that all participants left the proceedings impressed not only by the dramatic amount of progress that has been made in a short period of time, but also by the careful intellectual investigation and critical thinking that has gone into analyzing results and calculating further direction. We hope the reader is able to obtain the same fruits of labor from reading these proceedings of the meeting.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Patrick Nataf Michael Mack Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nataf, P. Articles by Mack, M. Search for Related Content PubMed Articles by Nataf, P. Articles by Mack, M.