Video-Assisted Cardiac Surgeries (VACS): Preliminary experience in acquired heart diseases

Purpose: VACS in surgical correction of intracardiac acquired lesions is still in its infancy. The preliminary experience of VACS in acquired heart diseases was reviewed. Method: VACS were performed in 13 patients (8 male and 5 female, aged 25 to 75, mean 39.7) from Sep. 1995 to Apr. 1996. The surgical indications were severe mitral regurgitation in 3 patients, thrombosis of mechanical mitral prosthesis in 2, left atrial tumor in 2, coronary artery disease in 3, severe tricuspid regurgitation in 2, and left ventricular thrombus with dilated cardiomyopathy in 1. Preoperatively, multiple organ failure occurred in 3 patients, cerebral embolization occurred in 2 patients, and sepsis was noted in 2 patient. All patients had congestive heart failure in NYHA functional class III or IV, except patients with coronary artery disease. Eight times sternotomies had been performed previously on these patients, once on 2 patients and twice on 3 patients. The surgeries were performed through right or left anterior minithoracotomy and guided by video-assisted endoscopic techniques under femora-femoral extracorporeal circulation. The aorta was not cross-clamped and the myocardium was protected by continuous coronary perfusion with hypothermic fibrillatory arrest (rectal temperature 22.5±0.5°C). Result: The operative procedures were thrombectomy of mitral prosthesis in 2 patients, mitral valve repair in 2, resection of left atrial tumor in 2, coronary artery bypass grafting in 3, mitral valve replacement in 1, tricuspid valve replacement in 1, tricuspid valvectomy in 1, and removal of left ventricular hematoma in 1. The bypass time was 144 to 320 minutes (185±55). One patient died 1 week postoperatively. Follow-up (1 to 7 months, mean 2.9) was complete in all survivors with one late death. The Survivors were found to be in NYHA functional class I or II. Conclusions: Our preliminary experience demonstrate that VACS is technically feasible and could be performed safely and effectively in the milieu of acquired heart disease. The minimally invasive nature of VACS can maximize the chance of survival.