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Management Of Left Luxation Of The Heart During Robotic Cardiac Surgery: “How I Do It”.
Xander Jacquemyn, Wouter Oosterlinck.
UZ Leuven, Leuven, Belgium.
OBJECTIVE: Cardiac luxation during robotic cardiac surgery is a potentially life-threatening complication that requires prompt and effective intervention to prevent hemodynamic collapse. Timely and composed surgical response is essential to ensure patient safety.
METHODS: We present our technique for managing left heart luxation outside the pericardium during robotic-assisted minimally invasive direct coronary artery bypass (MIDCAB) in a 45-year-old patient undergoing advanced hybrid bilateral internal mammary artery (BIMA) MIDCAB.
RESULTS: In our case, following the harvesting of both the right internal mammary artery (RIMA) and the left internal mammary artery (LIMA), hemodynamic compromise was observed during robotic manipulation of the thoracic drain in the left pleural space. The heart had luxated through the pericardial incision toward the left side, where the lung was deflated, dislodging the pericardial suspension stitch and the bulldog clamp on the RIMA, resulting in free bleeding into the pleural cavity. To manage this, we adjusted ventilation by inflating the left lung and deflating the right, creating counter-pressure to facilitate repositioning of the luxated heart. Simultaneously, the pericardium was maneuvered under and over the heart using the Resano Forceps to guide it back into the pericardial space with success. After repositioning, the procedure continued with tunneling of the RIMA and placement of a closing stitch in the pericardium, followed by completion of the anastomoses.
CONCLUSIONS: Left-sided cardiac luxation during robotic cardiac surgery can be effectively managed with prompt ventilation adjustment and pericardial manipulation. This approach quickly restores cardiac position and hemodynamic stability, ensuring patient safety. Our technique provides a reproducible method for managing similar intraoperative complications in robotic cardiac luxation.
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