Anastasiadis Kyriakos, Antonitsis Polychronis, Deliopoulos Apostolos, Argiriadou Helena
Cardiothoracic Department, AHEPA University Hospital, Thessaloniki, Greece.
J Thorac Dis. 2021 Mar;13(3):1909-1921. doi: 10.21037/jtd-20-1830.
Development of minimally invasive cardiac surgery (MICS) served the purpose of performing surgery while avoiding the surgical stress triggered by a full median sternotomy. Minimizing surgical trauma is associated with improved cosmesis and enhanced recovery leading to reduced morbidity. However, it has to be primarily appreciated that the extracorporeal circulation (ECC) stands for the basis of nearly all MICS procedures. With some fundamental modification and advancement in perfusion techniques, the use of ECC has become the enabling technology for the development of MICS. Less invasive cardiopulmonary bypass (CPB) techniques are based on remote cannulation and optimization of perfusion techniques with assisted venous drainage and use of centrifugal pump, so as to facilitate the demanding surgical maneuvers, rather than minimizing the invasiveness of the CPB. This is reflected in the increased duration of CPB required for MICS procedures. Minimal invasive Extracorporeal Circulation (MiECC) represents a major breakthrough in perfusion. It integrates all contemporary technological advancements that facilitate best applying cardiovascular physiology to intraoperative perfusion. Consequently, MiECC use translates to improved end-organ protection and clinical outcome, as evidenced in multiple clinical trials and meta-analyses. MICS performed with MiECC provides the basis for developing a multidisciplinary intraoperative strategy towards a "more physiologic" cardiac surgery by combining small surgical trauma with minimum body's physiology derangement. Integration of MiECC can advance MICS from non-full sternotomy for selected patients to a "more physiologic" surgery, which represents the real face of modern cardiac surgery in the transcatheter era.
微创心脏手术（MICS）的发展旨在在进行手术的同时，避免全胸骨正中切开术引发的手术应激。将手术创伤降至最低与改善美容效果和加快恢复进程相关联，从而降低发病率。然而，必须首先认识到体外循环（ECC）几乎是所有MICS手术的基础。随着灌注技术的一些根本性改进和进步，ECC的使用已成为MICS发展的 enabling 技术。侵入性较小的体外循环（CPB）技术基于远程插管以及通过辅助静脉引流和使用离心泵对灌注技术进行优化，以便于进行要求较高的手术操作，而不是将CPB的侵入性降至最低。这体现在MICS手术所需的CPB持续时间增加上。微创体外循环（MiECC）代表了灌注领域的一项重大突破。它整合了所有当代技术进步，便于在术中灌注中最佳地应用心血管生理学。因此，MiECC的使用转化为更好的终末器官保护和临床结果，多项临床试验和荟萃分析已证明了这一点。使用MiECC进行的MICS通过将小手术创伤与最小的身体生理紊乱相结合，为制定针对“更符合生理”的心脏手术的多学科术中策略提供了基础。MiECC的整合可以将MICS从针对特定患者的非全胸骨切开术推进到“更符合生理”的手术，这代表了经导管时代现代心脏手术的真实面貌。
