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. 2024 Nov 28;16(11):e74659.
doi: 10.7759/cureus.74659. eCollection 2024 Nov.

Establishing Minimally Invasive Cardiac Surgery in a Developing Country: A Five-Year Experience at Hayatabad Medical Complex, Pakistan

Muhammad Aasim  1 , Raheela Aziz  2 , Atta Ul Mohsin  1 , Raheel Khan  1 , Ayesha Zahid  2 , Jibran Ikram  2
Affiliations

Establishing Minimally Invasive Cardiac Surgery in a Developing Country: A Five-Year Experience at Hayatabad Medical Complex, Pakistan

Muhammad Aasim et al. Cureus. .

Abstract

Background The adoption of minimally invasive cardiac surgery (MICS) has increased over the past 25 to 30 years, driven by advancements in technology and a growing understanding of its benefits. This study evaluates the outcomes of 144 elective MICS procedures performed between January 2019 and September 2024. Methods Patients underwent various surgical approaches, including upper mini-sternotomy, mini-thoracotomy, and sub-xiphoid access. Patient demographics, preoperative characteristics, and surgical outcomes were analyzed. A total of 144 MICS procedures were performed. Results The cohort had a mean age of 30.72 years, with a nearly equal gender distribution, indicating that MICS can be performed safely in Pakistani patients. The mean ejection fraction was 53.58%, with hypertension being the most common comorbidity (22.2%). Aortic cannulation was primarily utilized, and aortic valve replacement (AVR) was the most common procedure (44.4%). The mean cardiopulmonary bypass (CPB) time was 95.9 ± 56.3 minutes and the mean aortic cross-clamp time was 62.22 ± 57.004 minutes, demonstrating efficient procedural times. The overall incidence of complications was low, supporting the safety and efficacy of MICS. Conclusion Our findings suggest that MICS is a viable and effective approach for a diverse patient population, with favorable clinical outcomes. The results underscore the potential for MICS to become standard practice in cardiothoracic surgery. Future research should focus on long-term outcomes and the influence of comorbidities to further enhance MICS methodologies.

Keywords: mini-sternotomy; minimal invasive cardiac surgery; minimal invasive direct coronary artery bypass; surgical outcomes; thoracotomy.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Upper mini-sternotomy
A: Shows upper mini-sternotomy for aortic valve replacement and aortic root enlargement. B: Shows upper mini-sternotomy for modified central shunt (Aasim’s shunt) in adult congenital heart disease with hypoplastic pulmonary valve severe stenosis and pulmonary vessels. C1 and C2: Shows upper mini-sternotomy for modified Bentall aortic valve replacement surgery as standard treatment for type A aortic dissection.
Figure 2
Figure 2. Left thoracotomy approach for MIDCAB
MIDCAB, minimally invasive direct coronary artery bypass.
Figure 3
Figure 3. Right mini-thoracotomy MICS for ASD-II closure, showing arrangements of the cardiopulmonary bypass cannulae and use of Cosgrove aortic cross-clamp
MICS, minimally invasive cardiac surgery; ASD-II, secundum atrial septal defect.
Figure 4
Figure 4. Illustration of distribution of cases
LAD, left anterior descending; PPM, permanent pacemaker; ASD, atrial septal defect; PDA, patent ductus arteriosus; AVR, aortic valve replacement; MIDCAB, minimally invasive direct coronary artery bypass; MVR: mitral valve replacement.
Figure 5
Figure 5. Types of incisions and their percentages
Figure 6
Figure 6. The distribution of cannulation techniques, highlighting that aortic cannulation (53.7%) was the most frequently employed, followed by femoral cannulation (2.7%)
The cases labeled as "no cannulation" (43.75%) in the graph represent procedures performed off bypass.
See this image and copyright information in PMC

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