Endovascular Cardiopulmonary Bypass for Port-Access Minimally Invasive Cardiac Surgery

Abstract

Port-Access (Heartport, Inc, Redwood City, CA) mini mally invasive cardiac surgery systems with the EndoCPB (Heartport, Inc) endovascular cardiopulmo nary bypass (CPB) system allow a variety of cardiac procedures to be performed on a quiescent, decom pressed heart through small incisions without the need for a median sternotomy. The catheter-based EndoCPB system uses a modified extracorporeal circuit to accom plish the same functions as a standard CPB system for open-chest cardiac surgery. Femoral and jugular cannu lae and catheters are positioned into the coronary sinus, pulmonary artery, and ascending aorta to arrest and vent the heart, deliver antegrade or retrograde cardiople gia, drain venous blood into a modified heart-lung machine, and return oxygenated blood into the periph eral circulation. Cannulae and catheter placement are guided by fluoroscopy and transesophageal echocardi ography (TEE) imaging. Specific monitoring techniques are used to continually evaluate the functioning of all system components to ensure safe and adequate CPB and myocardial protection. As of July 1998, a registry of clinical experience includes more than 1,800 Port- Access cases performed at more than 100 centers worldwide. The majority of procedures (57%) com pleted include coronary artery revascularization with multiple-vessel (up to six) distal anastomoses and mi tral valve replacements (17%) and repairs (10%). With experience, surgeons have begun to perform other intracardiac repairs on a wider range of patients than initially believed possible. Ongoing clinical experience and investigation will further elucidate the safety, effi cacy, and benefits of Port-Access minimally invasive cardiac procedures and the monitoring techniques and perioperative care methods best used to optimize clini cal care, reduce patient suffering, and facilitate rapid rehabilitation.