Right Heart Surgery: A Novel Minimally Invasive Surgical Technique and New Surgical Paradigm

Abstract

Objective: Right heart surgery is always considered as a challenge for minimal invasive cardiac surgery. Consideration of caval isolation remained the main obstacle over the years. We describe a novel minimal invasive caval isolation technique. Methods: We report as case, Female/Bangladeshi/45yrs known patient with Large secundum ASD with emodynamically significant left to right shunt (Qp/Qs = 2:1). Defect was not suitable for device closure. Results: Patient underwent minimally invasive cardiac surgery - OS ASD closure with bovine pericardial patch. Discharged well post-operative day 4. Rt ant-lat thoracotomy, Selective OLV. Cannulation: Arterial: RFA after groin exploration; Venous: i) SVC: US guided RIJV cannulation, occlusion: direct snare. IVC: RFV approach after groin exploration, occlusion: coda balloon occlusion of IVC from LFV. Aortic X-clamp: Chit-wood, cardioplegia- antegrade. Conclusions: Novel new occlusion technique worked well in our settings. This new surgical paradigm opened a new MIS window for right heart and bi-ventricular surgery.