Minimally Invasive Cardiac Surgery

Istituto Clinico St Ambrogio

key figures 

CLINICAL SERVICES VIA MINIMALLY INVASIVE TREATMENT:

  • Aortic Valvular Repair/Replacement
  • Mitral valve and tricuspid repair
  • Coronary artery bypass grafting
  • Concomitant or lone atrial fibrillation
  • Adult congenital disease treatment via TransCatheter Aortic Valve Implantation (TAVI)

Dr. Glauber and his team are professional tutors who collaborate with the major centres for minimally invasive cardiac surgery worldwide on training and education projects, including a formal collaboration with the Dubai Hospital.

Alongside the basic cardiac surgery activities, such as the aortocoronary bypass and the conventional valve surgery, there are newly developed minimally invasive techniques which enable heart valve surgery via a mini-thoracotomy, i.e. aortic, mitral and tricuspid valve reconstruction or replacement, the implantation of a new generation of sutureless aortic valves, the aortocoronary bypass through a left mini thoracotomy, and the insertion of transcatheter aortic valves (TAVI).

The Unit of Minimally Invasive Cardiac Surgery is in charge of the treatment of all the acquired or congenital cardiopathies in adult patients.

 

treatments

Adult Congenital or Acquired Aortic Diseases

The Minimally Invasive techniques are applied for aortic valvular repair/replacement through a right mini thoracotomy incision or a partial mini sternotomy. In addition, trans-catheter aortic valve implantation with transfemoral or transapical access (TAVI) are also performed. Some of the advantages of minimally invasive surgery are less blood loss, reduced post-operative discomfort, faster healing times and lowered risk of infections, as well as eliminating the risk of deep sternal wound infection or sternal non-union. More than 2000 aortic minimally invasive procedures have been performed to date. Combined aortic and mitral valve diseases can be simultaneously treated via minimally invasive approach. At the same time, Concomitant Coronary Artery Disease is routinely treated with percutaneous coronary intervention (hybrid procedure).

All forms of aortic pathologies are treated, from stenosis to insufficiency, aneurysm and dissections; from ascending aorta replacement, to aortic arch and descending thoraco-abdominal aorta replacement. The Unit is highly specialized in AVR with biological or mechanical traditional and Sutureless valves, Aortic Valve Repair and native aortic valve reimplantation.

Main Pathologies Treated:

  • Aortic Stenosis
  • Aortic Insufficiency
  • Aortic arch and descending thoracoabdominal aorta replacement

Top Procedures:

  • Minimally Invasive aortic valvular repair/replacement
    • Trans-catheter artic valve implantation (TAVI)
    • Right mini thracotomy incision
    • partial mini sterntomy
  • Hybrid Revascularization associated with valve surgery
    • Percutaneus Coronary Intervention (PCI)

Adult Acquired or Congenital mitral and tricuspid valve disease

The Unit has a long-standing experience in right mini-thoracotomy and thoracoscopic approach that avoids median sternotomy. These techniques provide great advantages under all respects, from post-operative recovery, to rehabilitation and also cosmetic results. Combined aortic and mitral valve diseases can be simultaneously treated via a minimally invasive approach. Meanwhile, Concomitant Coronary Artery Disease is routinely approached with a percutaneous coronary intervention (hybrid procedure).

All degenerative or functional mitral valve diseases, ischemic, rheumatic, infective mitral diseases are treated by the Unit’s team of experts. Mitral and tricuspid valve repair has a 99% success rate and 95% freedom from reoperation for a period of 10 years. Trans-apical beating-heart mitral valve repair with chordae implantation is also offered. This department is the only one in the Lombardy region, and one of the few in Italy, able to provide this treatment on a routine basis. More than 3000 procedures have been performed to date.

Main Pathologies Treated:

  • Degenerative mitral valve diseases
  • Functional mitral valve diseases
  • Ischemic, rheumatic, infective mitral valve diseases
  • Mitral and tricuspid valve repair and plasty

Top Procedures:

  • Right minithoracotomy
  • Thoracoscopic approach
  • Transapical beating-heart mitral valve repair
    • Chordae implantation

Ischemic Idiopathies

The Unit provides minimally Invasive single and multi-vessel bypass, hybrid treatments (MIDCAB + PCI) for ischemic idiopathies. It provides treatment for the left main and three vessel coronary artery disease, interventricular septal rupture, acute mitral insufficiency, pseudoaneurysm, and heart failure.  

It also provides Myocardial revascularization with arterial grafts, like beating-heart multi-vessel MICS CABG, a procedure performed under direct vision through an anterolateral mini-thoracotomy, left ventricle restoring and circulatory mechanical support.

Main Pathologies Treated:

  • Left main and three vessel coronary artery disease
  • Interventricular septal ruptures
  • Acute mitral insufficiency
  • Pseudoaneurysm
  • Heart failure

Top Procedures:

  • Myocardial revascularization with arterial grafts
  • Beating-heart multi-vessel MICS CABG procedure

Atrial Fibrillation

Atrial Fibrillation is treated with a minimally invasive approach by radiofrequency and/or cryo-atrial tissue ablation.

Main Pathologies Treated:

  • Paroxystic and Persistent Atrial fibrillation
  • Concomitant atrial fibrillation ablation during valve surgery

Top Procedures:

  • Thoracoscopic Lone AF ablation
  • Subxyphoid atrial fibrillation and Ventricular Tachycardia Ablation
  • Thoracoscopic Lead insertion
  • Thoracoscopic left appendage closure

 

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • 3D echocardiography
  • 3D endoscopy column
  • Sutureless valves
  • Left atrial appendage closure clip device