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BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting

Disseminating the practice of minimally invasive mitral surgery (mini-MVS) can be challenging, despite its original case reports a few decades ago. The penetration of this technology into clinical practice has been limited to centres of excellence, and mitral surgery in most general cardiothoracic c...

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Autores principales: Vohra, Hunaid A, Salmasi, M Yousuf, Chien, Lueh, Caputo, Massimo, Baghai, Max, Deshpande, Ranjit, Akowuah, Enoch, Ahmed, Ishtiaq, Tolan, Michael, Bahrami, Toufan, Hunter, Steven, Zacharias, Joseph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537434/
https://www.ncbi.nlm.nih.gov/pubmed/33020254
http://dx.doi.org/10.1136/openhrt-2020-001259
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author Vohra, Hunaid A
Salmasi, M Yousuf
Chien, Lueh
Caputo, Massimo
Baghai, Max
Deshpande, Ranjit
Akowuah, Enoch
Ahmed, Ishtiaq
Tolan, Michael
Bahrami, Toufan
Hunter, Steven
Zacharias, Joseph
author_facet Vohra, Hunaid A
Salmasi, M Yousuf
Chien, Lueh
Caputo, Massimo
Baghai, Max
Deshpande, Ranjit
Akowuah, Enoch
Ahmed, Ishtiaq
Tolan, Michael
Bahrami, Toufan
Hunter, Steven
Zacharias, Joseph
author_sort Vohra, Hunaid A
collection PubMed
description Disseminating the practice of minimally invasive mitral surgery (mini-MVS) can be challenging, despite its original case reports a few decades ago. The penetration of this technology into clinical practice has been limited to centres of excellence, and mitral surgery in most general cardiothoracic centres remains to be conducted via sternotomy access as a first line. The process for the uptake of mini-MVS requires clearer guidance and standardisation for the processes involved in its implementation. In this statement, a consensus agreement is outlined that describes the benefits of mini-MVS, including reduced postoperative bleeding, reduced wound infection, enhanced recovery and patient satisfaction. Technical considerations require specific attention and can be introduced through simulation and/or use in conventional cases. Either endoballoon or aortic cross clamping is recommended, as well as femoral or central aortic cannulation, with the use of appropriate adjuncts and instruments. A coordinated team-based approach that encourages ownership of the programme by the team members is critical. A designated proctor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases, is an important step to consider. The importance of pre-empting complications and dealing with adverse events is described, including re-exploration, conversion to sternotomy, unilateral pulmonary oedema and phrenic nerve injury. Accounting for both institutional and team considerations can effectively facilitate the introduction of a mini-MVS service. This involves simulation, team-based training, visits to specialist centres and involvement of a designated proctor to oversee the initial cases.
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spelling pubmed-75374342020-10-07 BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting Vohra, Hunaid A Salmasi, M Yousuf Chien, Lueh Caputo, Massimo Baghai, Max Deshpande, Ranjit Akowuah, Enoch Ahmed, Ishtiaq Tolan, Michael Bahrami, Toufan Hunter, Steven Zacharias, Joseph Open Heart Cardiac Surgery Disseminating the practice of minimally invasive mitral surgery (mini-MVS) can be challenging, despite its original case reports a few decades ago. The penetration of this technology into clinical practice has been limited to centres of excellence, and mitral surgery in most general cardiothoracic centres remains to be conducted via sternotomy access as a first line. The process for the uptake of mini-MVS requires clearer guidance and standardisation for the processes involved in its implementation. In this statement, a consensus agreement is outlined that describes the benefits of mini-MVS, including reduced postoperative bleeding, reduced wound infection, enhanced recovery and patient satisfaction. Technical considerations require specific attention and can be introduced through simulation and/or use in conventional cases. Either endoballoon or aortic cross clamping is recommended, as well as femoral or central aortic cannulation, with the use of appropriate adjuncts and instruments. A coordinated team-based approach that encourages ownership of the programme by the team members is critical. A designated proctor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases, is an important step to consider. The importance of pre-empting complications and dealing with adverse events is described, including re-exploration, conversion to sternotomy, unilateral pulmonary oedema and phrenic nerve injury. Accounting for both institutional and team considerations can effectively facilitate the introduction of a mini-MVS service. This involves simulation, team-based training, visits to specialist centres and involvement of a designated proctor to oversee the initial cases. BMJ Publishing Group 2020-10-05 /pmc/articles/PMC7537434/ /pubmed/33020254 http://dx.doi.org/10.1136/openhrt-2020-001259 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Cardiac Surgery
Vohra, Hunaid A
Salmasi, M Yousuf
Chien, Lueh
Caputo, Massimo
Baghai, Max
Deshpande, Ranjit
Akowuah, Enoch
Ahmed, Ishtiaq
Tolan, Michael
Bahrami, Toufan
Hunter, Steven
Zacharias, Joseph
BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting
title BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting
title_full BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting
title_fullStr BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting
title_full_unstemmed BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting
title_short BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting
title_sort bismics consensus statement: implementing a safe minimally invasive mitral programme in the uk healthcare setting
topic Cardiac Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537434/
https://www.ncbi.nlm.nih.gov/pubmed/33020254
http://dx.doi.org/10.1136/openhrt-2020-001259
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