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Ann Thorac Surg 1999;67:58
© 1999 The Society of Thoracic Surgeons

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Invited Commentary

^a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F-25, Cleveland, OH 44195, USA

Invited commentary

The winds of change in cardiac surgical procedures are blowing in many directions. The present report addresses one of those directions; operations performed through non–median sternotomy incisions supported by percutaneous cardiopulmonary bypass and the use of an intraaortic balloon catheter to achieve aortic occlusion and cardioplegia delivery. The data were collected by the Port-Access International Registry, a voluntary, industry-supported registry. Registries with these characteristics have clear advantages and disadvantages, but this report involves approximately 1,000 patients, representing the largest report of port-access surgical procedures thus far. The definitions of what port-access surgical procedures is will very likely change as instrumentation and robotics concepts progress, but fundamental to this concept of heart surgical procedures is the safety of the cardiopulmonary bypass–cardiac arrest system.

For the patients reported in this registry, the cardiopulmonary bypass–cardiac arrest system seems to have been relatively safe. The incidence of aortic dissection was 0.75% and improved with technologic changes and better patient selection. The risk of stroke was 2 to 3%. This is not an obviously high figure for a broad spectrum of patients undergoing cardiac procedures, but considering that the patient population in this report appears to have been a relatively low-risk group, this stroke risk is an issue that bears continued monitoring. It is important not to lose sight of the fact that these were selected patients, and this system will probably not be safe for all patients. The authors have identified aortic atherosclerosis as a relative contraindication to its use. Severe aortic atherosclerosis is a risk factor no matter what strategy for cardiopulmonary bypass is used, but it is possible to imagine safer ways of managing aortic atherosclerosis than to blow a balloon up inside of it. Nonetheless, the safety record of the system justifies the continued pursuit of this concept of "differently invasive" cardiac surgical procedures, and the current system will not be the last version of a cardiopulmonary bypass system developed to support port-access surgical procedures. The relative efficacy of the operations that were performed cannot be evaluated on the basis of the data in the present report. However, the demonstration of a relatively safe cardiopulmonary bypass–cardiac arrest system provides a platform for the continued improvement in instrumentation and technology that holds the promise of making these operations more precise and effective.

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First report of the port access international registry

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Ann. Thorac. Surg. 1999 67: 51-58. [Abstract] [Full Text] [PDF]

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				T. M. McLoitghlin JR Complications of Minimally Invasive Cardiac Surgical Procedures Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 1999; 3(2): 136 - 142. [Abstract] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bruce W. Lytle Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lytle, B. W. Search for Related Content PubMed Articles by Lytle, B. W. Related Collections Related Article