Standardization of video-assisted cardiac surgery technique: initial experience

Introduction: Minimally invasive cardiac surgery has been performed in major worldwide centers, including procedure such as valves, coronary and congenital surgery. Objective: To demonstrate our first works with noninvasive cardiac surgery by mean of the experience gained with general and thoracic surgery. Methods: Whenever possible to carry out a minimally invasive cardiac surgery, this was the approach of choice. The left thoracoscopy was used in four cases: (1) symptomatic coronary-pulmonary fistula ligation; (2) implant of an epicardial electrode into the left ventricle for resynchronization; (3) excision of pericardial giant lipoma in the left atrium, and (4) resection of hemangiolipoma in the mediastinum. Right thoracoscopy with extracorporeal circulation through cardiopulmonary bypass via femoral vein and artery and cardiac arrest in ventricular fibrillation with moderate hypothermia were carried out in the following cases: (5) patient with mitral stenosis after surgical repair with Carpentier ring 12 years before. An anterior and posterior commissurotomy without thoracotomy was successfully made; (6) patient with idiopathic dilated cardiomyopathy, high-response atrial fibrillation, and severe mitral insufficiency, underwent mitral repair surgery with Gregori's ring and ablation of the pulmonary veins with radio-frequency catheter. (MAZZE modified). Result: No death occurred in this series and the surgical result in all cases was highly satisfactory. All patients were discharged front hospital with a mean time of 5.5 +/- 5 days after intervention. Conclusion: Our initial experience in this field proves the effectiveness and the viability in introducing this type of technique.