Kinh nghiệm triển khai phẫu thuật tim ít xâm lấn tại BV ĐHYD, TP hồ chí minh

HOW SHOULD I SET UP A MINIMALLY INVASIVE PROGRAM UMC EXPERIENCES DR NGUYEN HOANG DINH DR LE MINH KHOI HEART CENTER UNIVERSITY MEDICAL CENTER HO CHI MINH CITY Why Minimally Invasive?  Patients benefits  Speed of recovery: “back to normal activities in weeks”, “decorated the house after weeks”  The desire to avoid a sternotomy and have less pain Minimally invasive Hospital/surgeon benefits  Large increase in referrals Speed of recovery  Sternotomy Invasiveness But…  It is technically challenging for the first 75-125 cases especially in inappropriately selected patients Holzhey et al Cirulation 2013:128(5):483-91  Almost poor outcomes can be attributed to  Learning curve of the operation  Patient selection Sternotomy vs MICS  Sternotomy: month recovery, pain, 1-2% DSWI, sternal precaution/no driving for weeks  Minimally invasive: times faster recovery, less pain, shorter hospital stay, driving after weeks, normal activities in weeks But new complications can occur  Longer cross-clamp and CPB time  Retrograde perfusion  Phrenic nerve palsy