© Tommaso Hinna Danesi, MD 2021
ECS
Endoscopic Cardiac Surgery
Totally Endoscopic Cardiac Surgery (ECS) is a surgical approach developed to minimize the surgical trauma. ECS is the cutting-edge approach in the field of minimally invasive surgery being a surgery requiring specific training and instruments
An experienced ECS Surgeon can approach all the heart's valves: mitral, aortic, tricuspid and pulmonic and perform many other open heart procedures.
ECS: Endoscopic Mitral Valve Repair
ECS: Endoscopic Aortic Valve Replacement
ECS: Endoscopic Multi Valve Surgery
Endoscopic Cardiac Surgery Access
Through a less than 2 cm incision - "Working Port" - and other two or three 5 mm "Mini-Ports" the Surgeon can bring inside the chest long shafted instruments, a micro camera and all the cardiac devices that usually are needed for an open heart surgery. Not needing any bone cut or chest spread the surgical trauma during an Endoscopic Cardiac Operation is strongly reduced. The meaning of Totally ECS surgery is to be respectful and gentle with the body and its tissue. Any Patient suffering of any valvular disease or some of the most common congenital heart's defect can benefit from an Endoscopic Cardiac Surgery approach. Even Patients who had a previous cardiac surgery both in standard or minimally invasive fashion can undergo an ECS procedure after careful evaluation. But remember Endoscopic Cardiac Surgery is still open heart surgery.
The Working Port
The Thoracoscope
ECS Benefits*
The Working Port is the largest incision. It ranges between 1 and 1.5 inch and allows the Surgeon to bring inside the chest instruments, camera and devices needed to fix the heart like valves, prosthesis and sutures. At the end of surgery the working post is closed and usually three months after the operation it can be barely seen.
ECS relies totally on a thoracoscope and its camera. These instruments replace the Surgeon's eyes enhancing his ability and capabilities providing a clear, magnified high-definition 4K images of the heart and its structures.
- Less pain
- Shorter intensive care and hospital stay
- Less surgical infection
- Less blood products need
- Less perioperative complications
- Faster postoperative recovery and back to normal life
- Better aesthetic results and postoperative comfort
Reduction of the surgical trauma leads to:*According to the literature available on PubMed
What can be treated with an Endoscopic Cardiac Surgery (ECS) approach?
Mitral Valve
Aortic Valve
Tricuspid Valve
Pulmonic Valve
All the spectrum of mitral valve disease can be addressed in an endoscopic fashion. Mitral regurgitation, mitral stenosis, mitral congenital defects, mitral infections. Doesn't matter if the Patient needs a valve repair or a replacement, both can be done through the "key-hole approach"
Aortic stenosis and aortic regurgitation can both be treated with the "key-hole" approach giving excellent, safe and durable result over the time. The magnified operating field view provides the Surgeon an extra-help in the procedure
A Totally Endoscopic surgical approach is ideal for tricuspid valve surgery. Infection, regurgitation, carcinoid syndrome, narrowing or congenital defect of the Tricuspid valve can be fixed through an Endoscopic approach. Surgery addressing the Tricuspid valve can be performed under beating heart
With a left-sided Working Port the Totally Endoscopic Cardiac Surgery Technique can be also applied to the pulmonic valve. As for the tricuspid valve, surgery on the pulmonic valve can be performed under beating heart
Atrial Septal Defects
Cardiac Tumors
Congenital Defects
Reoperation
Cardiac tumors are pretty rare and fortunately most of them are benign*. A Totally Endoscopic excision is feasible and safe with excellent results
* According to PubMed research
Reoparation is always an unfortunate event. A Totally Endoscopic procedure is feasible and safe in reoperations*, but only few Surgeons are experienced in redo Patients. ECS is safe and effective in redo Patients and most of the time allows the Surgeon not to arrest the heart to perform the operation
* According to PubMed literature
When the inner walls of the heart are missing some bricks leaving the interatrial septum open resulting in an abnormal communication between the right and the left side here the Endoscopic Cardiac Surgery comes. The septum can be repaired by simple suture or with a patch
Congenital defects are so many with a large variability in complexity. Low to mid complexity grade congenital defect like partial anomalous venous return to the left atrium, Djerbode defect of the Tricuspid valve, Left Ventricular Hypertrophic Obstructive CardioMyopathy (LVHOCM), membrabnous septum defects, Ebstein's anomaly can be efficiently addressed endoscopically in high volume ECS Centers
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Brigham and Women's Hospital, Heart and Vascular Center
Carl J. and Ruth Shapiro Cardiovascular Center
70 Francis Street
Boston, MA 02115
United States
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