Transesophageal echocardiography as a quality control tool in thoracoscopic cardiac surgery:4-years' experience
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摘要
Background The utilization value of intraoperative transesophageal echocardiography in cardiac surgery is more and more important. However,the role of intraoperative transesophageal echocardiography on quality control during thoracoscopic cardiac surgery has not been comprehensively studied. Methods A retrospective study of transesophageal echocardiography application on patients underwent thoracoscopic cardiac surgery from2012 to 2015 was conducted in a single cardiovascular center. General anesthesia and peripheral cardiopulmonary bypass were standardized for all patients. All procedures were performed through 3 holes made in the right chest wall. Transesophageal echocardiography monitoring was routinely utilized in each patient. Results A total of 1387 patients underwent thoracoscopic cardiac surgery were involved in the study. The mean age of patients was 42.8±15.3 years with a female predominance(60.6%). The most common procedures were mitral valve replacement(n=507,36.6%),atrial septal defect repair(n=425,30.6%),and mitral valve plasty(n=294,21.2%). Other main procedures included correction of partial anomalous pulmonary venous connection,cor triatriatum,ventricular septal defect or partial atrioventricular canal,removal of left or right atrial myxoma,and tricuspid valve plasty or replacement. Transesophageal echocardiography monitoring was useful at every stage of surgery without any major associated complications. Forty-four patients(3.2%)required surgical re-interventions immediately following transesophageal echocardiography evaluation. The reasons included unsatisfactory valve plasty,paravalvular leak,prosthetic dysfunction and residual shunting. The incidence of surgical re-intervention,as well as the mortality,decreased annually with increased surgical volume. Conclusions Intraoperative transesophageal echocardiography plays an important role in the quality control of thoracoscopic cardiac surgery.[S Chin J Cardiol 2019;20(2):69-78]
Background The utilization value of intraoperative transesophageal echocardiography in cardiac surgery is more and more important. However,the role of intraoperative transesophageal echocardiography on quality control during thoracoscopic cardiac surgery has not been comprehensively studied. Methods A retrospective study of transesophageal echocardiography application on patients underwent thoracoscopic cardiac surgery from2012 to 2015 was conducted in a single cardiovascular center. General anesthesia and peripheral cardiopulmonary bypass were standardized for all patients. All procedures were performed through 3 holes made in the right chest wall. Transesophageal echocardiography monitoring was routinely utilized in each patient. Results A total of 1387 patients underwent thoracoscopic cardiac surgery were involved in the study. The mean age of patients was 42.8±15.3 years with a female predominance(60.6%). The most common procedures were mitral valve replacement(n=507,36.6%),atrial septal defect repair(n=425,30.6%),and mitral valve plasty(n=294,21.2%). Other main procedures included correction of partial anomalous pulmonary venous connection,cor triatriatum,ventricular septal defect or partial atrioventricular canal,removal of left or right atrial myxoma,and tricuspid valve plasty or replacement. Transesophageal echocardiography monitoring was useful at every stage of surgery without any major associated complications. Forty-four patients(3.2%)required surgical re-interventions immediately following transesophageal echocardiography evaluation. The reasons included unsatisfactory valve plasty,paravalvular leak,prosthetic dysfunction and residual shunting. The incidence of surgical re-intervention,as well as the mortality,decreased annually with increased surgical volume. Conclusions Intraoperative transesophageal echocardiography plays an important role in the quality control of thoracoscopic cardiac surgery.[S Chin J Cardiol 2019;20(2):69-78]
Background The utilization value of intraoperative transesophageal echocardiography in cardiac surgery is more and more important. However,the role of intraoperative transesophageal echocardiography on quality control during thoracoscopic cardiac surgery has not been comprehensively studied. Methods A retrospective study of transesophageal echocardiography application on patients underwent thoracoscopic cardiac surgery from2012 to 2015 was conducted in a single cardiovascular center. General anesthesia and peripheral cardiopulmonary bypass were standardized for all patients. All procedures were performed through 3 holes made in the right chest wall. Transesophageal echocardiography monitoring was routinely utilized in each patient. Results A total of 1387 patients underwent thoracoscopic cardiac surgery were involved in the study. The mean age of patients was 42.8±15.3 years with a female predominance(60.6%). The most common procedures were mitral valve replacement(n=507,36.6%),atrial septal defect repair(n=425,30.6%),and mitral valve plasty(n=294,21.2%). Other main procedures included correction of partial anomalous pulmonary venous connection,cor triatriatum,ventricular septal defect or partial atrioventricular canal,removal of left or right atrial myxoma,and tricuspid valve plasty or replacement. Transesophageal echocardiography monitoring was useful at every stage of surgery without any major associated complications. Forty-four patients(3.2%)required surgical re-interventions immediately following transesophageal echocardiography evaluation. The reasons included unsatisfactory valve plasty,paravalvular leak,prosthetic dysfunction and residual shunting. The incidence of surgical re-intervention,as well as the mortality,decreased annually with increased surgical volume. Conclusions Intraoperative transesophageal echocardiography plays an important role in the quality control of thoracoscopic cardiac surgery.[S Chin J Cardiol 2019;20(2):69-78]
引文
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2.Chitwood WR,Jr..Robotic mitral valve surgery:overview,methodology,results,and perspective.Ann Cardiothorac Surg 2016,5:544-545.
3.Akowuah E,Burdett C,Khan K,et al.Early and late outcomes after minimally invasive mitral valve repair surgery.J Heart Valve Dis 2015,24:470-477.
4.Ma ZS,Yin QY,Dong MF,et al.Quality of life in patients undergoing totally thoracoscopic closure for atrial septal defect.Ann Thorac Surg 2011,92:2230-2234.
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7.Song S,Fan T,Li B,et al.Minimally invasive peratrial device closure of perimembranous ventricular septal defect through a right infraaxillary route:clinical experience and preliminary results.Ann Thorac Surg 2017,103:199-204.
8.Schneeberger Y,Schaefer A,Conradi L,et al.Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults:reconsideration of the standard of care.Interact Cardiovasc Thorac Surg 2017,24:603-608.
9.Shin H,Yozu R,Maehara T,et al.Vacuum assisted cardiopulmonary bypass in minimally invasive cardiac surgery:its feasibility and effects on hemolysis.Artif Organs 2000,24:450-453.
10.Jung JC,Kim KH.Minimally invasive cardiac surgery versus conventional median sternotomy for atrial septal defect closure.Korean J Thorac Cardiovasc Surg 2016,49:421-426.
11.Moscarelli M,Casula R,Speziale G,et al.Can we use minimally invasive mitral valve surgery as a safe alternative to sternotomy in high-risk patients?Interact Cardiovasc Thorac Surg 2016,22:92-96.
12.Malik V,Jha AK,Kapoor PM.Anesthetic challenges in minimally invasive cardiac surgery:Are we moving in a right direction?Ann Card Anaesth 2016,19:489-497.
13.Mahmood F,Shernan SK.Perioperative transoesophageal echocardiography:current status and future directions.Heart 2016,102:1159-1167.
14.Wang Y,Gao CQ,Wang JL,et al.The role of intraoperative transesophageal echocardiography in robotic mitral valve repair.Echocardiography 2011,28:85-91.
15.Bernstein WK,Walker A.Anesthetic issues for robotic cardiac surgery.Ann Card Anaesth 2015,18:58-68.
16.Bentala M,Heuts S,Vos R,et al.Comparing the endoaortic balloon and the external aortic clamp in minimally invasive mitral valve surgery.Interact Cardiovasc Thorac Surg 2015,21:359-365.
17.Vida VL,Tessari C,Putzu A,et al.The peripheral cannulation technique in minimally invasive congenital cardiac surgery.Int J Artif Organs 2016,39:300-303.
18.Casselman FP,Van Slycke S,Dom H,et al.Endoscopic mitral valve repair:feasible,reproducible,and durable.J Thorac Cardiovasc Surg 2003,125:273-282.
19.Loforte A,Luzi G,Montalto A,et al.Video-assisted minimally invasive mitral valve surgery:external aortic clamp versus endoclamp techniques.Ann Surg 2010,5:413-418.
20.Ma ZS,Dong MF,Yin QY,et al.Totally thoracoscopic repair of ventricular septal defect:a short-term clinical observation on safety and feasibility.J Thorac Cardiovasc Surg 2011,142:850-854.
21.Ma ZS,Dong MF,Yin QY,et al.Totally thoracoscopic repair of atrial septal defect without robotic assistance:a single-center experience.J Thorac Cardiovasc Surg 2011,141:1380-1383.
22.Vistarini N,Alloni A,Aiello M,et al.Minimally invasive video-assisted approach for left atrial myxoma resection.Interact Cardiovasc Thorac Surg 2010,10:9-11.
23.Wang F,Li M,Xu X,et al.Totally thoracoscopic surgical closure of atrial septal defect in small children.Ann Thorac Surg 2011,92:200-203.
24.Lei Q,Zeng QS,Zhang XS,et al.Bilateral subclavian vein sheaths for superior vena cava drainage during thoracoscopic repair of atrial septal defects:cosmetic outcomes,safety and effectiveness.Perfusion 2016,31:240-246.
25.Jha AK,Malik V,Hote M.Minimally invasive cardiac surgery and transesophageal echocardiography.Ann Card Anaesth 2014,17:125-132.
26.Nguyen TC,Lamelas J.From the ground up:building a minimally invasive aortic valve surgery program.Ann Cardiothorac Surg 2015,4:178-181.
27.De Praetere H,Verbrugghe P,Rega F,et al.Starting minimally invasive valve surgery using endoclamp technology:safety and results of a starting surgeon.Interact Cardiovasc Thorac Surg 2015,20:351-358.
28.Chandra S,Salgo IS,Sugeng L,et al.Characterization of degenerative mitral valve disease using morphologic analysis of real-time three-dimensional echocardiographic images:objective insight into complexity and planning of mitral valve repair.Circ Cardiovasc Imaging2011,4:24-32.
29.Hwang HY,Choi JW,Kim HK,et al.Paravalvular leak after mitral valve replacement:20-year follow-up.Ann Thorac Surg 2015,100:1347-1352.
30.Atluri P,Woo YJ,Goldstone AB,et al.Minimally invasive mitral valve surgery can be performed with optimal outcomes in the presence of left ventricular dysfunction.Ann Thorac Surg 2013,96:1596-1601.
2.Chitwood WR,Jr..Robotic mitral valve surgery:overview,methodology,results,and perspective.Ann Cardiothorac Surg 2016,5:544-545.
3.Akowuah E,Burdett C,Khan K,et al.Early and late outcomes after minimally invasive mitral valve repair surgery.J Heart Valve Dis 2015,24:470-477.
4.Ma ZS,Yin QY,Dong MF,et al.Quality of life in patients undergoing totally thoracoscopic closure for atrial septal defect.Ann Thorac Surg 2011,92:2230-2234.
5.Nguyen TC,Thourani VH,Pham JQ,et al.Traditional sternotomy versus minimally invasive aortic valve replacement in patients stratified by ejection fraction.Innovations 2017,12:33-40.
6.Baishya J,George A,Krishnamoorthy J,et al.Minimally invasive compared to conventional approach for coronary artery bypass grafting improves outcome.Ann Card Anaesth 2017,20:57-60.
7.Song S,Fan T,Li B,et al.Minimally invasive peratrial device closure of perimembranous ventricular septal defect through a right infraaxillary route:clinical experience and preliminary results.Ann Thorac Surg 2017,103:199-204.
8.Schneeberger Y,Schaefer A,Conradi L,et al.Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults:reconsideration of the standard of care.Interact Cardiovasc Thorac Surg 2017,24:603-608.
9.Shin H,Yozu R,Maehara T,et al.Vacuum assisted cardiopulmonary bypass in minimally invasive cardiac surgery:its feasibility and effects on hemolysis.Artif Organs 2000,24:450-453.
10.Jung JC,Kim KH.Minimally invasive cardiac surgery versus conventional median sternotomy for atrial septal defect closure.Korean J Thorac Cardiovasc Surg 2016,49:421-426.
11.Moscarelli M,Casula R,Speziale G,et al.Can we use minimally invasive mitral valve surgery as a safe alternative to sternotomy in high-risk patients?Interact Cardiovasc Thorac Surg 2016,22:92-96.
12.Malik V,Jha AK,Kapoor PM.Anesthetic challenges in minimally invasive cardiac surgery:Are we moving in a right direction?Ann Card Anaesth 2016,19:489-497.
13.Mahmood F,Shernan SK.Perioperative transoesophageal echocardiography:current status and future directions.Heart 2016,102:1159-1167.
14.Wang Y,Gao CQ,Wang JL,et al.The role of intraoperative transesophageal echocardiography in robotic mitral valve repair.Echocardiography 2011,28:85-91.
15.Bernstein WK,Walker A.Anesthetic issues for robotic cardiac surgery.Ann Card Anaesth 2015,18:58-68.
16.Bentala M,Heuts S,Vos R,et al.Comparing the endoaortic balloon and the external aortic clamp in minimally invasive mitral valve surgery.Interact Cardiovasc Thorac Surg 2015,21:359-365.
17.Vida VL,Tessari C,Putzu A,et al.The peripheral cannulation technique in minimally invasive congenital cardiac surgery.Int J Artif Organs 2016,39:300-303.
18.Casselman FP,Van Slycke S,Dom H,et al.Endoscopic mitral valve repair:feasible,reproducible,and durable.J Thorac Cardiovasc Surg 2003,125:273-282.
19.Loforte A,Luzi G,Montalto A,et al.Video-assisted minimally invasive mitral valve surgery:external aortic clamp versus endoclamp techniques.Ann Surg 2010,5:413-418.
20.Ma ZS,Dong MF,Yin QY,et al.Totally thoracoscopic repair of ventricular septal defect:a short-term clinical observation on safety and feasibility.J Thorac Cardiovasc Surg 2011,142:850-854.
21.Ma ZS,Dong MF,Yin QY,et al.Totally thoracoscopic repair of atrial septal defect without robotic assistance:a single-center experience.J Thorac Cardiovasc Surg 2011,141:1380-1383.
22.Vistarini N,Alloni A,Aiello M,et al.Minimally invasive video-assisted approach for left atrial myxoma resection.Interact Cardiovasc Thorac Surg 2010,10:9-11.
23.Wang F,Li M,Xu X,et al.Totally thoracoscopic surgical closure of atrial septal defect in small children.Ann Thorac Surg 2011,92:200-203.
24.Lei Q,Zeng QS,Zhang XS,et al.Bilateral subclavian vein sheaths for superior vena cava drainage during thoracoscopic repair of atrial septal defects:cosmetic outcomes,safety and effectiveness.Perfusion 2016,31:240-246.
25.Jha AK,Malik V,Hote M.Minimally invasive cardiac surgery and transesophageal echocardiography.Ann Card Anaesth 2014,17:125-132.
26.Nguyen TC,Lamelas J.From the ground up:building a minimally invasive aortic valve surgery program.Ann Cardiothorac Surg 2015,4:178-181.
27.De Praetere H,Verbrugghe P,Rega F,et al.Starting minimally invasive valve surgery using endoclamp technology:safety and results of a starting surgeon.Interact Cardiovasc Thorac Surg 2015,20:351-358.
28.Chandra S,Salgo IS,Sugeng L,et al.Characterization of degenerative mitral valve disease using morphologic analysis of real-time three-dimensional echocardiographic images:objective insight into complexity and planning of mitral valve repair.Circ Cardiovasc Imaging2011,4:24-32.
29.Hwang HY,Choi JW,Kim HK,et al.Paravalvular leak after mitral valve replacement:20-year follow-up.Ann Thorac Surg 2015,100:1347-1352.
30.Atluri P,Woo YJ,Goldstone AB,et al.Minimally invasive mitral valve surgery can be performed with optimal outcomes in the presence of left ventricular dysfunction.Ann Thorac Surg 2013,96:1596-1601.