Minimally invasive heart valve surgery: already established in clinical routine?
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Minimally invasive heart valve surgery: already established in clinical routine? / Gulbins, Helmut; Pritisanac, Anita; Hannekum, Andreas.
in: EXPERT REV CARDIOVAS, Jahrgang 2, Nr. 6, 11.2004, S. 837-843.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Minimally invasive heart valve surgery: already established in clinical routine?
AU - Gulbins, Helmut
AU - Pritisanac, Anita
AU - Hannekum, Andreas
PY - 2004/11
Y1 - 2004/11
N2 - Cardiac valve replacement with the need for open heart surgery still has the highest morbidity and mortality rates among routine cardiac surgery, with the exception of aortic aneurysm repair and surgery for congenital heart defects. Reducing invasiveness is a desirable goal, and different strategies and approaches have been used to achieve this with valve repair or replacement less invasive. Despite the good results reported with minimally invasive techniques, time on extracorporal circulation is always longer compared with the conventional procedures. Since these techniques do not reduce real invasiveness but rather improve the cosmetic results, minimal-access surgery would be a better nomenclature. With the exception of patients at a high risk for sternal infections or redo heart operations, a reduction in postoperative morbidity by the avoidance of a median sternotomy is not yet definitely proven. Meanwhile, most surgeons comply with the demand for minimally invasive surgery posed by patients by reducing the length of the incision in aortic valve replacement and by using a right anterolateral approach with a limited incision for mitral valve operations. However, the use of endoscopic or robotic devices is limited to a few centers, and has not yet found its way into clinical routine. Nonetheless, minimally invasive or minimal-access surgery is now established in many centers, and patients should always be informed of these techniques. When this information is provided objectively and patient selection is carried out accurately, these alternative approaches can help to improve postoperative convalescence.
AB - Cardiac valve replacement with the need for open heart surgery still has the highest morbidity and mortality rates among routine cardiac surgery, with the exception of aortic aneurysm repair and surgery for congenital heart defects. Reducing invasiveness is a desirable goal, and different strategies and approaches have been used to achieve this with valve repair or replacement less invasive. Despite the good results reported with minimally invasive techniques, time on extracorporal circulation is always longer compared with the conventional procedures. Since these techniques do not reduce real invasiveness but rather improve the cosmetic results, minimal-access surgery would be a better nomenclature. With the exception of patients at a high risk for sternal infections or redo heart operations, a reduction in postoperative morbidity by the avoidance of a median sternotomy is not yet definitely proven. Meanwhile, most surgeons comply with the demand for minimally invasive surgery posed by patients by reducing the length of the incision in aortic valve replacement and by using a right anterolateral approach with a limited incision for mitral valve operations. However, the use of endoscopic or robotic devices is limited to a few centers, and has not yet found its way into clinical routine. Nonetheless, minimally invasive or minimal-access surgery is now established in many centers, and patients should always be informed of these techniques. When this information is provided objectively and patient selection is carried out accurately, these alternative approaches can help to improve postoperative convalescence.
KW - Adult
KW - Aged
KW - Female
KW - Heart Valve Diseases/diagnosis
KW - Heart Valve Prosthesis
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Length of Stay
KW - Male
KW - Middle Aged
KW - Minimally Invasive Surgical Procedures/adverse effects
KW - Pain, Postoperative/physiopathology
KW - Patient Satisfaction
KW - Postoperative Complications/mortality
KW - Prognosis
KW - Randomized Controlled Trials as Topic
KW - Risk Assessment
KW - Survival Rate
KW - Thoracotomy/methods
KW - Treatment Outcome
U2 - 10.1586/14779072.2.6.837
DO - 10.1586/14779072.2.6.837
M3 - SCORING: Review article
C2 - 15500429
VL - 2
SP - 837
EP - 843
JO - EXPERT REV CARDIOVAS
JF - EXPERT REV CARDIOVAS
SN - 1477-9072
IS - 6
ER -