1
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Lio A, Russo M, Sangiorgi B, Nicolò F, Chirichilli I, Irace F, Ranocchi F, Musumeci F. Robotic Mitral Valve Repair: Impact of Experience on Results and Complex Mitral Disease Treatment. J Clin Med 2024; 13:3744. [PMID: 38999310 PMCID: PMC11242621 DOI: 10.3390/jcm13133744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Robotically assisted mitral valve (MV) surgery is the least invasive surgical approach to the MV. The aim of the present study is to report our experience with robotically assisted MV repair, trying to define how experience could impact on postoperative results. Methods: This is a retrospective study on 144 patients who underwent robotic MV repair from November 2011 to March 2023. Patients were divided in two groups: Group 1, including 39 patients (November 2011-January 2013) operated using the Da Vinci Si system, and Group 2, including 105 patients operated (February 2020-March 2023) using the new Da Vinci Xi system. Results: Mean age was 58 ± 10 years. Increased use of external aortic clamp was observed in Group 2. A significant reduction of surgical times was observed: cardiopulmonary bypass time was 155 ± 44 min in Group 1 and 121 ± 36 min in Group 2 (p = 0.002), whereas cross-clamp time was 112 ± 25 min in Group 1 and 68 ± 39 min in Group 2 (p < 0.001). In-hospital mortality was 0.7%, and 10-year survival was 96 ± 2%. Freedom from reoperation was 100%. A higher percentage of complex and most complex MV repairs were performed in Group 2 (36% in Group 1 vs. 52% in Group 2, p = 0.001). Conclusions: Robotic-assisted MV repair is associated with excellent results. Experience is a key element to overcome the limitations of this technology. Finally, the robotic platform could improve results in difficult MV repair.
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Affiliation(s)
- Antonio Lio
- Department of Cardiac Surgery and Transplantation, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy; (M.R.); (B.S.); (F.N.); (I.C.); (F.I.); (F.R.); (F.M.)
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2
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Loulmet DF, Grossi EA. Two decades of experience with robotic mitral valve repair: What have we learned? JTCVS Tech 2024; 24:76-81. [PMID: 38835581 PMCID: PMC11145349 DOI: 10.1016/j.xjtc.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Didier F. Loulmet
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Eugene A. Grossi
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
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3
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Massey J, Palmer K, Al-Rawi O, Chambers O, Ridgway T, Shanmuganathan S, Soppa G, Modi P. Robotic mitral valve surgery. Front Cardiovasc Med 2024; 10:1239742. [PMID: 38505666 PMCID: PMC10948479 DOI: 10.3389/fcvm.2023.1239742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/19/2023] [Indexed: 03/21/2024] Open
Abstract
Totally endoscopic robotic mitral valve repair is the least invasive surgical therapy for mitral valve disease. Robotic mitral valve surgery demonstrates faster recovery with shorter hospital stays, less morbidity, and equivalent mortality and mid-term durability compared to sternotomy. In this review, we will explore the advantages and disadvantages of robotic mitral valve surgery and consider important technical details of both operative set-up and mitral valve repair techniques. The number of robotic cardiac surgical procedures being performed globally is expected to continue to rise as experience grows with robotic techniques and increasing numbers of cardiac surgeons become proficient with this innovative technology. This will be facilitated by the introduction of newer robotic systems and increasing patient demand.
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Affiliation(s)
| | | | | | | | | | | | | | - Paul Modi
- Department of Cardiothoracic Surgery, The Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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4
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Rufa M, Nagib R, Aktuerk D, Ahad S, Ghinescu M, Franke U. A propensity matched comparison of robotic vs. traditional minimal access approach for mitral valve repair with concomitant cryoablation. J Thorac Dis 2023; 15:6459-6474. [PMID: 38249871 PMCID: PMC10797378 DOI: 10.21037/jtd-23-1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/20/2023] [Indexed: 01/23/2024]
Abstract
Background Atrial fibrillation (AF) occurs frequently in patients with mitral valve disease. Results of cryoablation concomitant with either minimally invasive video-assisted [minimally invasive mitral valve surgery (MIMVS)] or with robotic-assisted (RMV) mitral valve surgery have previously been separately reported. However, there are up-to-date no studies comparing the two procedures in terms of safety, efficacy, and mid-term follow-up. Methods Between January 2017 and March 2022, 294 patients underwent MIMVS, and 187 patients underwent RMV at our institution. After 1:1 propensity score matching using 22 preoperative variables, the study included 104 patients. Group 1 (MIMVS) included 52 patients operated on between 2017-2022 using a minimally invasive video-assisted right-sided mini-thoracotomy. Group 2 (RMV) included 52 patients operated on between 2019-2021 using a robotic-assisted approach. Early and mid-term outcomes were assessed, including maintenance of sinus rhythm. Follow-up was 100% complete at a median follow-up of 2 years. Results For the entire propensity matched cohort, the median EuroSCORE II was 3.14 [interquartile range (IQR), 1.93-4.99], the median age was 68 (IQR, 61-74) years, and two thirds of the patients were male. Most (72.1%) underwent mitral valve surgery, and 26.9% had an additional tricuspid procedure. Only four patients underwent mitral valve replacement (3.8%). The majority (87.5%) received a left-sided atrial Maze and 12.5% a bi-atrial Maze. The left atrial appendage was occluded in 72.1% cases. Overall, there were no significant differences between the two propensity matched groups in baseline demographics or intra-operative characteristics. Similarly, there were no significant differences in the post-operative short and mid-term outcomes between the two groups. There were no in-hospital or 30-day deaths. At the mid-term survival was similar between groups, log-rank test P=0.056. Maintenance of sinus rhythm at follow-up was 76%. Conclusions Mitral or double valve repair with concomitant cryoablation can be safely performed with either a MIMVS or RMV approach. Both methods demonstrated outstanding early and mid-term outcomes.
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Affiliation(s)
- Magdalena Rufa
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ragi Nagib
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | | | - Samir Ahad
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Mihnea Ghinescu
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ulrich Franke
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
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5
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Yokoyama C, Yoshitnai K, Ogata S, Fukushima S, Matsuda H. Effect of postoperative delirium after cardiovascular surgery on 5-year mortality. JA Clin Rep 2023; 9:66. [PMID: 37831211 PMCID: PMC10575819 DOI: 10.1186/s40981-023-00658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Postoperative delirium is a common complication after cardiovascular surgery. A meta-analysis revealed that postoperative delirium was associated with cognitive decline and dementia, which may affect long-term mortality. However, few studies have reported the association between postoperative delirium after cardiovascular surgery and long-term postoperative mortality. Therefore, we investigated the effect of postoperative delirium on 5-year survival rates of patients who underwent cardiovascular surgery. METHODS We retrospectively reviewed the records of patients who underwent cardiovascular surgery with cardiopulmonary bypass from January 2016 to December 2019. Postoperative delirium was defined as an Intensive Care Delirium Screening score ≥ 3, which might include subclinical delirium. Cox proportional hazards modeling was performed to assess the association between postoperative delirium and mortality. Postoperative mortality in patients with and without delirium was assessed using the Kaplan-Meier method and compared using the log-rank test. RESULTS Postoperative delirium was observed in 562 (31.9%) of 1731 patients. There were more elderly patients, more emergent surgery procedures, longer operative time, and larger transfusion volume in the postoperative delirium group. Cox regression analyses showed that delirium (hazard ratio (HR), 1.501; 95% confidence interval (CI), 1.053-2.140; p = 0.025) and emergent surgery (HR, 3.380; 95% CI, 2.231-5.122; p < 0.001) are significantly associated with 5-year mortality. Among patients who underwent elective surgery, postoperative delirium (HR, 1.987; 95% CI, 1.135-3.481; p = 0.016) is significantly associated with 5-year mortality. Kaplan-Meier survival analysis revealed that patients with postoperative delirium had significantly higher 5-year mortality. CONCLUSIONS Patients with postoperative delirium after cardiovascular surgery have significantly higher 5-year mortality.
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Affiliation(s)
- Chisaki Yokoyama
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1, Kishibeshinmachi, Suita, Osaka, Japan
| | - Kenji Yoshitnai
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1, Kishibeshinmachi, Suita, Osaka, Japan.
| | - Soshiro Ogata
- Department of, Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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6
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Sandoval E, Muro A, Navarro R, García-Álvarez A, Castellà M, Pereda D. Implementation and clinical impact of a robotic heart surgery program. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:739-741. [PMID: 37182723 DOI: 10.1016/j.rec.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Elena Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Anna Muro
- Servicio de Cirugía Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Ricard Navarro
- Servicio de Anestesiología, Hospital Clínic, Barcelona, Spain
| | - Ana García-Álvarez
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Castellà
- Servicio de Cirugía Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Daniel Pereda
- Servicio de Cirugía Cardiovascular, Hospital Clínic, Barcelona, Spain; Servicio de Cardiología, Hospital Clínic, Barcelona, Spain.
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Giroletti L, Brembilla V, Graniero A, Albano G, Villari N, Roscitano C, Parrinello M, Grazioli V, Lanzarone E, Agnino A. Learning Curve Analysis of Robotic-Assisted Mitral Valve Repair with COVID-19 Exogenous Factor: A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1568. [PMID: 37763687 PMCID: PMC10536190 DOI: 10.3390/medicina59091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background and objective Renewed interest in robot-assisted cardiac procedures has been demonstrated by several studies. However, concerns have been raised about the need for a long and complex learning curve. In addition, the COVID-19 pandemic in 2020 might have affected the learning curve of these procedures. In this study, we investigated the impact of COVID-19 on the learning curve of robotic-assisted mitral valve surgery (RAMVS). The aim was to understand whether or not the benefits of RAMVS are compromised by its learning curve. Materials and Methods Between May 2019 and March 2023, 149 patients underwent RAMVS using the Da Vinci® X Surgical System at the Humanitas Gavazzeni Hospital, Bergamo, Italy. The selection of patients enrolled in the study was not influenced by case complexity. Regression models were used to formalize the learning curves, where preoperative data along with date of surgery and presence of COVID-19 were treated as the input covariates, while intraoperative and postoperative data were analyzed as output variables. Results The age of patients was 59.1 ± 13.3 years, and 70.5% were male. In total, 38.2% of the patients were operated on during the COVID-19 pandemic. The statistical analysis showed the positive impact of the learning curve on the trend of postoperative parameters, progressively reducing times and other key indicators. Focusing on the COVID-19 pandemic, statistical analysis did not recognize an impact on postoperative outcomes, although it became clear that variables not directly related to the intervention, especially ICU hours, were strongly influenced by hospital logistics during COVID-19. Conclusions Understanding the learning curve of robotic surgical procedures is essential to ensure their effectiveness and benefits. The learning curve involves not only surgeons but also other health care providers, and establishing a stable team in the early stage, as in our case, is important to shorten the duration. In fact, an exogenous factor such as the COVID-19 pandemic did not affect the robotic program despite the fact that the pandemic occurred early in the program.
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Affiliation(s)
- Laura Giroletti
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Valentina Brembilla
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Ascanio Graniero
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Nicola Villari
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Matteo Parrinello
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Valentina Grazioli
- Cardiovascular Surgery Department, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy;
| | - Ettore Lanzarone
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Alfonso Agnino
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
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8
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Tomšič A, Palmen M. Robotic mitral valve repair surgery: where do we go from here? Front Cardiovasc Med 2023; 10:1156495. [PMID: 37293277 PMCID: PMC10244781 DOI: 10.3389/fcvm.2023.1156495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Surgical mitral valve repair through median sternotomy has long presented the treatment of choice for degenerative mitral valve disease. In recent decades, minimal invasive surgical techniques have been developed and are now gaining widespread popularity. Robotic cardiac surgery presents an emerging field, initially adopted only by selected centres, mostly in the United States. In recent years, the number of centers interested in robotic mitral valve surgery has grown with an increasing adoption in Europe as well. Increasing interest and surgical experience gained are stimulating further developments in the field and the full potential of robotic mitral valve surgery remains to be developed.
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9
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Fatehi Hassanabad A, Nagase FNI, Basha AM, Hammal F, Menon D, Kent WDT, Ali IS, Nagendran J, Stafinski T. A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:471-481. [PMID: 36529985 PMCID: PMC9846568 DOI: 10.1177/15569845221141488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy. METHODS A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible. RESULTS The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches. CONCLUSIONS Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada,Ali Fatehi Hassanabad, MD, MSc, Section of
Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute,
Foothills Medical Center, 1403, 29th Street NW, Calgary, Alberta, T2N2T9,
Canada.
| | - Fernanda N. I. Nagase
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ameen M. Basha
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Fadi Hammal
- School of Public Health, University of
Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Imtiaz S. Ali
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department
of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton,
AB, Canada
| | - Tania Stafinski
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
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10
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Chitwood WR. Historical evolution of robot-assisted cardiac surgery: a 25-year journey. Ann Cardiothorac Surg 2022; 11:564-582. [PMID: 36483613 PMCID: PMC9723535 DOI: 10.21037/acs-2022-rmvs-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/05/2022] [Indexed: 08/18/2023]
Abstract
Many patients and surgeons today favor the least invasive access to an operative site. The adoption of robot-assisted cardiac surgery has been slow, but now has come to fruition. The development of modern surgical robots took surgeons close collaboration with mechanical, electrical, and optical engineers. Moreover, the necessary project funding required entrepreneurs, federal grants, and venture capital. Non-robotic minimally invasive cardiac surgery paved the way to the application of surgical robots by making changes in operative approaches, instruments, visioning modalities, cardiopulmonary perfusion techniques, and especially surgeons' attitudes. In this article, the serial development of robot-assisted cardiac surgery is detailed from the beginning and through clinical application. Included are references to the historical and most recent clinical series that have given us the evidence that robot-assisted cardiac surgery is safe and provides excellent outcomes. To this end, in many institutions these procedures now have become a new standard of care. This evolution reflects Sir Isaac Newton's famous 1676 quote when referring to Rene Descartes, "If have seen further [sic] than others, it is by standing on the shoulders of giants".
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Affiliation(s)
- W Randolph Chitwood
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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11
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Reparación robótica de la válvula mitral. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Agnino A, Graniero A, Villari N, Roscitano C, Gerometta P, Albano G, Anselmi A. Evaluation of robotic-assisted mitral surgery in a contemporary experience. J Cardiovasc Med (Hagerstown) 2022; 23:399-405. [PMID: 35645031 DOI: 10.2459/jcm.0000000000001319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To evaluate the safety/effectiveness of a recently established robotic-assisted mitral surgery program. METHODS Cohort study with prospective collection of clinical data of 59 consecutive recipients (May 2019-August 2021) of robotic-assisted (fourth-generation platform, DaVinci X) mitral valve repair for degenerative disease, using a totally endoscopic technique. Patients' selection was based on defined anatomical and clinical criteria. We established a dedicated multidisciplinary protocol to facilitate postoperative fast-tracking, and a systematic in-house clinical and echocardiographic follow-up at 3, 6, and 12 postoperative months. RESULTS All patients (89.8% men, average age 58 ± 12 years) received mitral valve repair; there was no operative mortality, one conversion to sternotomy (1.7%) and one stroke (1.7%). Extubation within the operative theater occurred in 28.8%; average mechanical ventilation time and ICU stay was 2.8 ± 4.1 and 32.5 ± 15.8 h (after exclusion of one outlier, learning-curve period, suffering from perioperative stroke); average postoperative hospital stay was 6.8 ± 3.4 days and 96.6% of patients were discharged home. One patient was transfused (1.7%); there were no other complications. Follow-up revealed stability of the results of mitral repair, with one (1.7%) persistent (>2+/4+) mitral regurgitation, and stability of coaptation height over time. We observed optimal functional results (class I was 98% at 3 months and 96% at 12 months). Quarterly case load consistently increased during the experience. CONCLUSION This initial experience suggests the reliability and clinical safety of a recently established local robotic-assisted mitral surgery. This strategy can facilitate faster postoperative recovery, and its positioning in the therapeutic armamentarium needs to be defined.
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Affiliation(s)
- Alfonso Agnino
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery
| | - Ascanio Graniero
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery
| | - Nicola Villari
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | | | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital.,Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
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Hodges K, Burns D, Gillinov AM, Suri R. Commentary: Surgical treatment of atrial fibrillation at the time of cardiac surgery: Just do it. JTCVS Tech 2021; 10:82-83. [PMID: 34984365 PMCID: PMC8691930 DOI: 10.1016/j.xjtc.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - A. Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Rakesh Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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14
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Hamandi M, Hafen L, Squiers JJ, Lanfear AT, DiMaio JM, Smith RL. A Review of Robotic Mitral Valve Surgery. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2020.1866230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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15
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Toolan C, Palmer K, Al-Rawi O, Ridgway T, Modi P. Robotic mitral valve surgery: a review and tips for safely negotiating the learning curve. J Thorac Dis 2021; 13:1971-1981. [PMID: 33841983 PMCID: PMC8024858 DOI: 10.21037/jtd-20-1790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Totally endoscopic robotic mitral valve repair represents the least invasive surgical therapy for mitral valve disease. Comparative results for robotic mitral valve surgery against sternotomy are impressive, repeatedly demonstrating shorter hospital stay, faster return to normal activities, less morbidity and equivalent mortality and mid-term durability. We lack data comparing robotic approaches to totally endoscopic minimally invasive mitral valve surgery using 3D vision platforms. In this review, we explore the advantages and disadvantages of robotic mitral valve surgery and share technical tips that we have learned to help teams embarking on their robotic journey. We consider factors necessary for the successful implementation of a robotic programme including the importance of training a dedicated team, with the common goal to avoid any compromise in either patient safety or repair quality during the learning curve. As experience grows with robotic techniques and more cardiac surgeons become proficient with this innovative technology, the volume of robotic cardiac procedures around the world will increase helped by the introduction of new robotic systems and patient demand. Well informed patients will increasingly seek out the opportunity of robotic valve reconstruction in reference centres in the hands of a few highly experienced robotic surgeons.
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Affiliation(s)
| | | | - Omar Al-Rawi
- The Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Tim Ridgway
- The Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Paul Modi
- The Liverpool Heart & Chest Hospital, Liverpool, UK
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Minimally invasive and transcatheter approaches for mitral valve surgery. Indian J Thorac Cardiovasc Surg 2020; 36:492-501. [PMID: 33061160 DOI: 10.1007/s12055-019-00901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/22/2019] [Accepted: 11/07/2019] [Indexed: 10/24/2022] Open
Abstract
Mitral valve surgery has evolved through the ages, in response to prevalent epidemiology of mitral pathologies. In the modern era, advances in technology has allowed physicians to help a wider spectrum on increasingly sicker patients. This review summarises these advances and its associated evidence base for safety and efficacy.
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Commentary: Don't stress for the unnecessary stress. JTCVS Tech 2020; 4:269-270. [PMID: 34318040 PMCID: PMC8306895 DOI: 10.1016/j.xjtc.2020.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022] Open
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Early results of robotically assisted mitral valve repair in a single institution: report of the first 100 cases. Gen Thorac Cardiovasc Surg 2020; 68:1079-1085. [DOI: 10.1007/s11748-020-01317-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Meta-analysis of propensity matched studies of robotic versus conventional mitral valve surgery. J Cardiol 2020; 75:177-181. [DOI: 10.1016/j.jjcc.2019.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/27/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
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Tasar R, Tkebuchava S, Diab M, Doenst T. An 86-Year-Old Female with Mitral Regurgitation and Significant Pectus Excavatum. Thorac Cardiovasc Surg Rep 2019; 8:e37-e40. [PMID: 31871852 PMCID: PMC6923716 DOI: 10.1055/s-0039-1700881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background
We report the case of minimally invasive mitral valve repair in an 86-year-old female with symptomatic structural mitral regurgitation and severe pectus excavatum.
Case Description
The case summarizes four areas of repetitive heart team discussions. First, should an 86-year-old patient still be treated invasively? Second, if so, should treatment be interventional or surgical? Third, if surgical, should we replace or repair at that age and fourth which surgical access is best with respect to her chest deformation?
Conclusion
We chose to surgically repair the valve using a minimally invasive approach. The patient was extubated 3 hours after surgery and discharged after 7 days.
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Affiliation(s)
- Raphael Tasar
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Sophie Tkebuchava
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
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Radwan M, Bon D, Dressen L, Walther T, Miscovic A, Moritz A, Papadopoulos N. Propensity-Matched Comparison of Two Different Access Modes for Minimally Invasive Mitral Valve Surgery. Semin Thorac Cardiovasc Surg 2019; 32:36-44. [PMID: 31445088 DOI: 10.1053/j.semtcvs.2019.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 11/11/2022]
Abstract
Mitral valve surgery is being performed routinely using minimally invasive operative techniques. We aimed comparing perioperative and long-term outcomes of minimally invasive mitral valve surgery using 2 different surgical approaches, partial upper sternotomy (PUS) vs right anterolateral minithoracotomy (RAT). From January 1998 through December 2015, 1006 patients underwent mitral valve surgery using a minimally invasive access in our institution. Logistic regression analysis was used to identify covariates among 18 patient variables including the type of mitral valve surgery. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 243 patients each. Results are based on the matched cohorts between the 2 groups. The PUS approach was performed by 8 surgeons whereas the RAT approach by 2. PUS led to slightly longer duration of the cross-clamp time (100 ± 28 vs 88 ± 26 minutes, P < 0.001) whereas ventilation time (9 ± 37 vs 11 ± 66 hours, P < 0.001) was shorter in PUS than in RAT group. Besides the number of pacemaker implants (PUS: 6.6% vs RAT: 0.4, P = 0.0005) and postoperative chest tube drainage amount at 24 hours (PUS: 556 ± 557 mL/24 h vs RAT: 716 ± 580 mL/24 h, P < 0.001) no differences between the 2 groups regarding further perioperative outcome were observed. Long-term survival and freedom from mitral valve reintervention were comparable between the 2 groups at 6- and 8 years' follow-up. Minimally invasive mitral valve surgery can be performed safely using a PUS or RAT approach without any differences regarding perioperative and long-term morbidity and mortality. Although the RAT approach may be cosmetically more appealing in female patients, PUS may facilitate both safe performance of mitral valve surgery and resident training.
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Affiliation(s)
- Medhat Radwan
- Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Dimitra Bon
- Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt/Main, Frankfurt, Germany; German Center for Cardiovascular Research, DZHK, Partner Site Rhein-Main, Berlin, Germany
| | - Laura Dressen
- Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Alexandra Miscovic
- Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Anton Moritz
- Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
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Outcomes and Resource Utilization in Robotic Mitral Valve Repair: Beyond the Learning Curve. J Surg Res 2019; 235:258-263. [DOI: 10.1016/j.jss.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
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Doenst T, Diab M, Sponholz C, Bauer M, Färber G. The Opportunities and Limitations of Minimally Invasive Cardiac Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:777-784. [PMID: 29229038 DOI: 10.3238/arztebl.2017.0777] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/05/2017] [Accepted: 09/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over the past two decades, minimally invasive techniques for classic heart valve surgery and isolated bypass surgery have been developed that enable access to the heart via partial sternotomy for most aortic valve procedures and via sternotomy-free mini-thoracotomy for other procedures. METHODS We review the current evidence on minimally invasive cardiac surgery on the basis of pertinent randomized studies and database studies retrieved by a selective search in the MEDLINE and PubMed Central databases, as well as by the Google Scholar search engine. RESULTS A PubMed search employing the search term "minimally invasive cardiac surgery" yielded nearly 10 000 hits, among which there were 7 prospective, randomized, controlled trials (RCTs) on aortic valve replacement, with a total of 477 patients, and 3 RCTs on mitral valve surgery, with a total of 340 patients. Only limited reports of specified centers are currently available for multiple valvular procedures and multiple coronary artery bypass procedures. The RCTs reveal that the minimally invasive techniques are associated with fewer wound infections and faster mobilization, without any difference in survival. Minimally invasive procedures are technically demanding and have certain anatomical prerequisites, such as appropriate coronary morphology for multiple bypass operations and the position of the aorta in the chest for sternotomy-free aortic valve procedures. The articles reviewed here were presumably affected by selection bias, in that patients in the published studies were preselected, and there may have been negative studies that were not published at all. CONCLUSION Specialized surgeons and centers can now carry out many cardiac valvular and bypass operations via minithoracotomy rather than sternotomy. According to current evidence, these minimally invasive techniques yield results that are at least as good as classic open-heart surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller Universität Jena; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller Universität Jena
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Wang A, Brennan JM, Zhang S, Jung SH, Yerokun B, Cox ML, Jacobs JP, Badhwar V, Suri RM, Thourani V, Halkos ME, Gammie JS, Gillinov AM, Smith PK, Glower D. Robotic Mitral Valve Repair in Older Individuals: An Analysis of The Society of Thoracic Surgeons Database. Ann Thorac Surg 2018; 106:1388-1393. [DOI: 10.1016/j.athoracsur.2018.05.074] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
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Coyan G, Wei LM, Althouse A, Roberts HG, Schauble D, Murashita T, Cook CC, Rankin JS, Badhwar V. Robotic mitral valve operations by experienced surgeons are cost-neutral and durable at 1 year. J Thorac Cardiovasc Surg 2018; 156:1040-1047. [DOI: 10.1016/j.jtcvs.2018.03.147] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/12/2018] [Accepted: 03/02/2018] [Indexed: 11/29/2022]
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Hawkins RB, Mehaffey JH, Mullen MG, Nifong WL, Chitwood WR, Katz MR, Quader MA, Kiser AC, Speir AM, Ailawadi G. A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery. Heart 2018; 104:1970-1975. [PMID: 29915143 DOI: 10.1136/heartjnl-2018-313129] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Institutional studies suggest robotic mitral surgery may be associated with superior outcomes. The objective of this study was to compare the outcomes of robotic, minimally invasive (mini), and conventional mitral surgery. METHODS A total of 2300 patients undergoing non-emergent isolated mitral valve operations from 2011 to 2016 were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by approach: robotic (n=372), mini (n=576) and conventional sternotomy (n=1352). To account for preoperative differences, robotic cases were propensity score matched (1:1) to both conventional and mini approaches. RESULTS The robotic cases were well matched to the conventional (n=314) and mini (n=295) cases with no significant baseline differences. Rates of mitral repair were high in the robotic and mini cohorts (91%), but significantly lower with conventional (76%, P<0.0001) despite similar rates of degenerative disease. All procedural times were longest in the robotic cohort, including operative time (224 vs 168 min conventional, 222 vs 180 min mini; all P<0.0001). The robotic approach had comparable outcomes to the conventional approach except there were fewer discharges to a facility (7% vs 15%, P=0.001) and 1 less day in the hospital (P<0.0001). However, compared with the mini approach, the robotic approach had more transfusions (15% vs 5%, P<0.0001), higher atrial fibrillation rates (26% vs 18%, P=0.01), and 1 day longer average hospital stay (P=0.02). CONCLUSION Despite longer procedural times, robotic and mini patients had similar complication rates with higher repair rates and shorter length of stay metrics compared with conventional surgery. However, the robotic approach was associated with higher atrial fibrillation rates, more transfusions and longer postoperative stays compared with minimally invasive approach.
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Affiliation(s)
- Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew G Mullen
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Wiley L Nifong
- Division of Cardiac Surgery, East Carolina University, Greenville, North Carolina, USA
| | - W Randolph Chitwood
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Marc R Katz
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andy C Kiser
- Division of Cardiac Surgery, East Carolina University, Greenville, North Carolina, USA
| | - Alan M Speir
- INOVA Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
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Eljilany I, El-Dahiyat F, Curley LE, Babar ZUD. Evaluating quantity and quality of literature focusing on health economics and pharmacoeconomics in Gulf Cooperation Council countries. Expert Rev Pharmacoecon Outcomes Res 2018; 18:403-414. [PMID: 29779401 DOI: 10.1080/14737167.2018.1479254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The importance of pharmacoeconomics and health economics has been augmented. It has the potential to provide evidence to aid in optimal decision-making in the funding of cost-effective medicines and services in Gulf Cooperation Council countries (G.C.C). OBJECTIVE To evaluate the quality and quantity of health economic researches published until the end of 2017 in G.C.C. and to identify the factors that affect the quality of studies. METHOD Studies were included according to predefined inclusion and exclusion criteria. The quantity was recorded, and the quality was assessed using the Quality of Health Economic Studies (QHES) instrument. RESULTS Forty-nine studies were included. The mean (SD) quality score of all studies was 57.83 (25.05), and a high number of reviewed studies (47%) were evaluated as either poor or extremely poor quality. The factors that affect the quality of studies with statistical significance were, the type and method of economic evaluation, the economic outcome was the objective of the research, author`s background, the perspective of the study, health intervention and source of funding. CONCLUSION The use of economic evaluation studies in G.C.C was limited. Different factors that affect the quality of articles such as performing a full economic evaluation and choosing societal perspective were identified. Strategies to improve the quality of future studies were recommended.
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Affiliation(s)
- Islam Eljilany
- a Independent Researcher , Pharmacoeconomics Expert , Qatar
| | - Faris El-Dahiyat
- b College of Pharmacy , Al Ain University of Science and Technology , Al Ain , United Arab Emirates
| | - Louise Elizabeth Curley
- c School of Pharmacy, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Zaheer-Ud-Din Babar
- c School of Pharmacy, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand.,d Department of Pharmacy , University of Huddersfield , Huddersfield , United Kingdom
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Abstract
PURPOSE OF REVIEW In this review, we discuss the current evidence supporting each minimally invasive mitral repair approach and their associated controversies. RECENT FINDINGS Current evidence demonstrates that minimally invasive mitral repair techniques yield similar mitral repair results to conventional sternotomy with the benefits of shorter hospital stay, quicker recovery, better cosmesis and improved patient satisfaction. Despite this, broad adoption of minimally invasive mitral repair is still not achieved. Two main approaches of minimally invasive mitral repair exist: endoscopic mini-thoracotomy and robotic-assisted approaches. SUMMARY Both minimally invasive approaches share many commonalities; however, most centres are strongly polarized to one approach over another creating controversy and debate about the most effective minimally invasive approach.
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Gillinov AM, Mihaljevic T, Javadikasgari H, Suri RM, Mick SL, Navia JL, Desai MY, Bonatti J, Khosravi M, Idrees JJ, Lowry AM, Blackstone EH, Svensson LG. Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases. J Thorac Cardiovasc Surg 2018; 155:82-91.e2. [DOI: 10.1016/j.jtcvs.2017.07.037] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 02/07/2023]
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Goodman A, Koprivanac M, Kelava M, Mick SL, Gillinov AM, Rajeswaran J, Brzezinski A, Blackstone EH, Mihaljevic T. Robotic Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Avi Goodman
- Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Marta Kelava
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Stephanie L. Mick
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - A. Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH USA
| | - Anna Brzezinski
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH USA
| | - Tomislav Mihaljevic
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
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Robotic Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:390-397. [DOI: 10.1097/imi.0000000000000438] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective Adoption of robotic mitral valve surgery has been slow, likely in part because of its perceived technical complexity and a poorly understood learning curve. We sought to correlate changes in technical performance and outcome with surgeon experience in the “learning curve” part of our series. Methods From 2006 to 2011, two surgeons undertook robotically assisted mitral valve repair in 458 patients (intent-to-treat); 404 procedures were completed entirely robotically (as-treated). Learning curves were constructed by modeling surgical sequence number semiparametrically with flexible penalized spline smoothing best-fit curves. Results Operative efficiency, reflecting technical performance, improved for (1) operating room time for case 1 to cases 200 (early experience) and 400 (later experience), from 414 to 364 to 321 minutes (12% and 22% decrease, respectively), (2) cardiopulmonary bypass time, from 148 to 102 to 91 minutes (31% and 39% decrease), and (3) myocardial ischemic time, from 119 to 75 to 68 minutes (37% and 43% decrease). Composite postoperative complications, reflecting safety, decreased from 17% to 6% to 2% (63% and 85% decrease). Intensive care unit stay decreased from 32 to 28 to 24 hours (13% and 25% decrease). Postoperative stay fell from 5.2 to 4.5 to 3.8 days (13% and 27% decrease). There were no in-hospital deaths. Predischarge mitral regurgitation of less than 2+, reflecting effectiveness, was achieved in 395 (97.8%), without correlation to experience; return-to-work times did not change substantially with experience. Conclusions Technical efficiency of robotic mitral valve repair improves with experience and permits its safe and effective conduct.
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Koprivanac M, Kelava M, Alansari S, Javadikasgari H, Tappuni B, Mick S, Marc GA, Suri R, Mihaljevic T. Degenerative mitral valve disease-contemporary surgical approaches and repair techniques. Ann Cardiothorac Surg 2017; 6:38-46. [PMID: 28203540 DOI: 10.21037/acs.2016.11.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes.
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Affiliation(s)
- Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marta Kelava
- Department of Cardiothoracic Anesthesiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shehab Alansari
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hoda Javadikasgari
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bassman Tappuni
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephanie Mick
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gillinov A Marc
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rakesh Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Tomislav Mihaljevic
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates
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Kim HJ, Kim JB, Jung SH, Lee JW. Clinical outcomes of robotic mitral valve repair: a single-center experience in Korea. Ann Cardiothorac Surg 2017; 6:9-16. [PMID: 28203536 DOI: 10.21037/acs.2016.10.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Since the inception of robotic mitral valve repair (MV) in 2007 at our institution, it has become an acceptable surgical option with proven efficacy and safety. The objective of this study is to analyze the early and long-term clinical outcomes of patients undergoing robotic MV repair. METHODS A total of 310 patients (aged 48.4±13.7 years, 201 males) undergoing robotic MV repair using the da Vinci system (Intuitive Surgical, Inc., Sunnyvale, CA) between August 2007 and December 2015 in our institution were evaluated. The preoperative demographics, operative profiles and postoperative outcomes including follow-up echocardiographic results were analyzed. RESULTS Successful MV repair was achieved in 98.4% (n=305) of patients, with no significant residual mitral regurgitation (MR) postoperatively. There were no early postoperative deaths. Early postoperative complications included: stroke (n=3, 1.0%), new onset dialysis (n=1, 0.3%) and reoperation (n=3, 1.0%). During a median follow-up of 55.7 months (inter-quartile range 30.3 to 81.3 months), six (1.9%) patients died, while four patients underwent late reoperation for mitral regurgitation (n=2) or infective endocarditis (n=2). Major event-free survival at five years was 87.6%. Late echocardiographic profiles (>6 months) were obtained in 295 (95.2%) patients. During follow-up, 32 (10.8%) patients developed significant mitral regurgitation (MR > grade 2), while freedom from significant MR at five years was 86.5%. CONCLUSIONS Robotic MV repair is a safe procedure with acceptable postoperative results, including low early postoperative morbidity and mortality and acceptable long-term repair durability.
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Affiliation(s)
- Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract
Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a "gold standard" valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches.
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Affiliation(s)
- Emmanuel Moss
- Division of Cardiac Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael E Halkos
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Javadikasgari H, Suri RM, Tappuni B, Lowry AM, Mihaljevic T, Mick S, Gillinov AM. Robotic mitral valve repair for degenerative posterior leaflet prolapse. Ann Cardiothorac Surg 2017; 6:27-32. [PMID: 28203538 DOI: 10.21037/acs.2017.01.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Robotic mitral valve (MV) repair is the least invasive surgical approach to the MV and provides unparalleled access to the valve. We sought to assess technical aspects and clinical outcomes of robotic MV repair for isolated posterior leaflet prolapse by examining the first 623 such cases performed in a tertiary care center. METHODS We reviewed the first 623 patients (mean age 56±9.7 years) with isolated posterior leaflet prolapse who underwent robotic primary MV repair from 01/2006 to 11/2013. All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. RESULTS MV repair was attempted in all patients; 622 (99.8%) underwent MV repair and only 1 (0.2%) converted to replacement. After an initial attempt at robotic MV repair, 8 (1.3%) patients were converted to sternotomy as a result of management of residual mitral regurgitation (n=3), bleeding (n=1), difficulties with surgical exposure (n=2), aortic valve injury (n=1), and aortic dissection (n=1). Intraoperative post-repair echocardiography confirmed that all patients left the operating room with MR graded as mild or less, and pre-discharge echocardiography confirmed mild or less MR in 573 (99.1%). There was no hospital death, sternal wound infection, or renal failure. Seven (1.1%) patients suffered a stroke, 11 (1.8%) patients underwent re-exploration for bleeding, and 111 (19%) experienced new-onset atrial fibrillation. The mean intensive care unit length of stay and hospital length of stay were 29±17 hours and 4.6±1.6 days, respectively. CONCLUSIONS At a large tertiary care referral center, robotic MV repair for posterior prolapse is associated with zero mortality, infrequent operative morbidity, and near 100% successful repair. The combination of a patient selection algorithm and increased experience improved clinical outcomes and procedural efficiency.
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Chitwood WR. Robotic mitral valve surgery: overview, methodology, results, and perspective. Ann Cardiothorac Surg 2016; 5:544-555. [PMID: 27942486 DOI: 10.21037/acs.2016.03.16] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Robotic mitral valve repair began in 1998 and has advanced remarkably. It arose from an interest in reducing patient trauma by operating through smaller incisions with videoscopic assistance. In the United States, following two clinical trials, the FDA approved the daVinci Surgical System in 2002 for intra-cardiac surgery. This device has undergone three iterations, eventuating in the current daVinci XI. At present it is the only robotic device approved for mitral valve surgery. Many larger centers have adopted its use as part of their routine mitral valve repair armamentarium. Although these operations have longer perfusion and arrest times, complications have been either similar or less than other traditional methods. Preoperative screening is paramount and leads to optimal patient selection and outcomes. There are clear contraindications, both relative and absolute, that must be considered. Three-dimensional (3D) echocardiographic studies optimally guide surgeons in operative planning. Herein, we describe the selection criteria as well as our operative management during a robotic mitral valve repair. Major complications are detailed with tips to avoid their occurrence. Operative outcomes from the author's series as well as those from the largest experiences in the United States are described. They show that robotic mitral valve repair is safe and effective, as well as economically reasonable due to lower costs of hospitalization. Thus, the future of this operative technique is bright for centers adopting the "heart team" approach, adequate clinical volume and a dedicated and experienced mitral repair surgeon.
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Affiliation(s)
- W Randolph Chitwood
- Emeritus Chairman, Department of Surgery, Brody School of Medicine, Greenville, NC, USA; ; Founding Director, East Carolina Heart Institute, East Carolina University, Greenville, NC, USA; ; Visting Professor, University of Virginia, Charlottesville, VA, USA
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Javadikasgari H, Suri RM, Gillinov AM. Robotic mitral valve repair: algorithmic approach in degenerative mitral valve disease. Ann Cardiothorac Surg 2016; 5:586-588. [PMID: 27942493 DOI: 10.21037/acs.2016.11.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hoda Javadikasgari
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Gillinov AM, Suri R, Mick S, Mihaljevic T. Robotic mitral valve surgery: current limitations and future directions. Ann Cardiothorac Surg 2016; 5:573-576. [PMID: 27942490 DOI: 10.21037/acs.2016.03.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Use of the surgical robot facilitates less invasive mitral valve surgery. Although multiple single center studies confirmed excellent results with robotically-assisted mitral valve surgery, both real and perceived limitations have slowed adoption of this technology. Some still question the safety and efficacy of robotically-assisted mitral valve surgery. However, present data suggests that robotic operations can be performed by specialized surgeons in appropriately selected patients without compromising results. That said, the robot does introduce additional procedural complexity related to management of cardiopulmonary bypass and myocardial protection. A direct approach to these challenges combined with careful patient selection enables the surgeon to obtain excellent results with robotically-assisted mitral valve surgery.
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Kowalewski M, Malvindi PG, Suwalski P, Raffa GM, Pawliszak W, Perlinski D, Kowalkowska ME, Kowalewski J, Carrel T, Anisimowicz L. Clinical Safety and Effectiveness of Endoaortic as Compared to Transthoracic Clamp for Small Thoracotomy Mitral Valve Surgery: Meta-Analysis of Observational Studies. Ann Thorac Surg 2016; 103:676-686. [PMID: 27765173 DOI: 10.1016/j.athoracsur.2016.08.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/18/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022]
Abstract
Controversies remain on the increased rate of neurological events after small thoracotomy mitral valve surgery attributed to endoaortic balloon occlusion (EABO). Systematic literature search of databases identified 17 studies enrolling 6,643 patients comparing safety and effectiveness of EABO versus transthoracic clamp. In a meta-analysis, there was no difference in occurrence of cerebrovascular events, all-cause mortality, and kidney injury. EABO was associated with a significantly higher risk of iatrogenic aortic dissection (0.93% versus 0.13%; risk ratio, 4.67; 95% confidence interval, 1.62 to 13.49; p = 0.004) and a trend toward longer operative times. The data is limited to observational studies.
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Affiliation(s)
- Mariusz Kowalewski
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland; Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz, Bydgoszcz, Poland.
| | - Pietro Giorgio Malvindi
- University Hospital Southampton NHS Foundation Trust, Wessex Cardiothoracic Centre, Southampton, United Kingdom
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland; Faculty of Health Science and Physical Education, Pulaski University of Technology and Humanities, Radom, Poland
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Wojciech Pawliszak
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Damian Perlinski
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
| | - Magdalena Ewa Kowalkowska
- Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Janusz Kowalewski
- Lung Cancer and Thoracic Surgery Department, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Thierry Carrel
- Clinic for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
| | - Lech Anisimowicz
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
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Minimally invasive mitral valve surgery: a review of the literature. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Suri RM, Dearani JA, Mihaljevic T, Chitwood WR, Murphy DA, Trento A, Javadikasgari H, Burkhart HM, Nifong WL, Daly RC, Gillinov AM. Mitral valve repair using robotic technology: Safe, effective, and durable. J Thorac Cardiovasc Surg 2016; 151:1450-4. [PMID: 27012453 DOI: 10.1016/j.jtcvs.2016.02.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 02/01/2016] [Accepted: 02/18/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Tomislav Mihaljevic
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - W Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Douglas A Murphy
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | | | - Hoda Javadikasgari
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Wiley L Nifong
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Kang CH, Bok JS, Lee NR, Kim YT, Lee SH, Lim C. Current Trend of Robotic Thoracic and Cardiovascular Surgeries in Korea: Analysis of Seven-Year National Data. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:311-7. [PMID: 26509124 PMCID: PMC4622026 DOI: 10.5090/kjtcs.2015.48.5.311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 12/16/2022]
Abstract
Background Robotic surgery is an alternative to minimally invasive surgery. The aim of this study was to report on current trends in robotic thoracic and cardiovascular surgical techniques in Korea. Methods Data from the National Evidence-based Healthcare Collaborating Agency (NECA) between January 2006 and June 2012 were used in this study, including a total of 932 cases of robotic surgeries reported to NECA. The annual trends in the case volume, indications for robotic surgery, and distribution by hospitals and surgeons were analyzed in this study. Results Of the 932 cases, 591 (63%) were thoracic operations and 340 (37%) were cardiac operations. The case number increased explosively in 2007 and 2008. However, the rate of increase regained a steady state after 2011. The main indications for robotic thoracic surgery were pulmonary disease (n=271, 46%), esophageal disease (n=199, 34%), and mediastinal disease (n=117, 20%). The main indications for robotic cardiac surgery were valvular heart disease (n=228, 67%), atrial septal defect (n=79, 23%), and cardiac myxoma (n=27, 8%). Robotic thoracic and cardiovascular surgeries were performed in 19 hospitals. Three large volume hospitals performed 94% of the case volume of robotic cardiac surgery and 74% of robotic thoracic surgery. Centralization of robotic operation was significantly (p<0.0001) more common in cardiac surgery than in thoracic surgery. A total of 39 surgeons performed robotic surgeries. However, only 27% of cardiac surgeons and 23% of thoracic surgeons performed more than 10 cases of robotic surgery. Conclusion Trend analysis of robotic and cardiovascular operations demonstrated a gradual increase in the surgical volume in Korea. Meanwhile, centralization of surgical cases toward specific surgeons in specific hospitals was observed.
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Affiliation(s)
- Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Jin San Bok
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Na Rae Lee
- Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Seon Heui Lee
- Department of Nursing Science, Gachon University College of Nursing
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
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Suri RM, Taggarse A, Burkhart HM, Daly RC, Mauermann W, Nishimura RA, Li Z, Dearani JA, Michelena HI, Enriquez-Sarano M. Robotic Mitral Valve Repair for Simple and Complex Degenerative Disease: Midterm Clinical and Echocardiographic Quality Outcomes. Circulation 2015; 132:1961-8. [PMID: 26481775 DOI: 10.1161/circulationaha.115.017792] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe primary (degenerative) mitral regurgitation (MR) is repaired with durable results when simple single-scallop disease is addressed. The midterm quality outcomes of minimally invasive repair for complex disease are unknown, however. METHODS AND RESULTS From January 2008 to January 2015, 487 patients (56±11 years, 360 men, ejection fraction 65±6%, 98.8% complete follow-up) underwent robotic mitral valve repair for severe nonischemic degenerative MR. Simple pathology was addressed in 289 of 487 (59%) patients, and complex repair (all others) was performed in 198 of 487 (41%). Four patients died during follow-up with a 5-year survival rate 99.5% (99.4% simple; 99.5% complex; hazard ratio, 0.48; 95% confidence interval, 0.05-4.59); and New York Heart Association functional class I/II was documented in 97.9% (477/487). Eight patients had recurrence of moderate-to-severe MR (4 simple, 4 complex), with a 5-year freedom from MR of 94.6% (96.2% simple; 92.7%, complex; P=0.67; hazard ratio, 1.36; 95% confidence interval, 0.34-5.43). Seven patients (2 simple, 5 complex), underwent mitral reoperation, with a 5-year freedom from reoperation of 97.7% (99.1% simple; 95.7% complex; P=0.13; hazard ratio, 3.35; 95% confidence interval, 0.65-17.32). CONCLUSIONS At a large tertiary care referral center, midterm quality outcomes after robotic correction of degenerative MR are excellent, with very high survival, infrequent complications, and a low likelihood of MR recurrence, regardless of mitral valve repair complexity. Awareness of these improvements in outcome is important to inform contemporary decisions regarding high-quality alternatives to conventional and percutaneous mitral repair.
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Affiliation(s)
- Rakesh M Suri
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
| | - Amit Taggarse
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
| | - Harold M Burkhart
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
| | - Richard C Daly
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
| | - William Mauermann
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
| | - Rick A Nishimura
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
| | - Zhuo Li
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
| | - Hector I Michelena
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
| | - Maurice Enriquez-Sarano
- From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN
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Abstract
For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term "cardiac surgery". The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with "solid ground" for up-to-date decision-making in cardiac surgery.
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Canale LS, Colafranceschi AS. Is robotic mitral valve surgery more expensive than its conventional counterpart?: Table 1:. Interact Cardiovasc Thorac Surg 2015; 20:844-7. [DOI: 10.1093/icvts/ivv038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 02/12/2015] [Indexed: 11/13/2022] Open
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Lamelas J, Nguyen TC. Minimally Invasive Valve Surgery: When Less Is More. Semin Thorac Cardiovasc Surg 2015; 27:49-56. [DOI: 10.1053/j.semtcvs.2015.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/11/2022]
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Revuelta JM. La reparación de la insuficiencia mitral entre 2 orillas. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Minithoracotomy for mitral valve repair improves inpatient and postdischarge economic savings. J Thorac Cardiovasc Surg 2014; 148:2818-22.e1-3. [DOI: 10.1016/j.jtcvs.2014.08.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/02/2014] [Accepted: 08/18/2014] [Indexed: 11/22/2022]
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Algarni KD, Suri RM, Daly RC. Robotic-assisted mitral valve repair: surgical technique. Multimed Man Cardiothorac Surg 2014; 2014:mmu022. [PMID: 25362732 DOI: 10.1093/mmcts/mmu022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Robotic-assisted mitral valve repair represents the least invasive surgical approach currently available for anatomical mitral valve repair in patients with myxomatous mitral valve disease. Standard mitral valve repair techniques utilized during conventional sternotomy/right thoracotomy are exactly replicated with the robotic instrumentation through 1-2 cm port-like incisions with superior 3D visualization. This is performed on cardiopulmonary bypass by peripheral cannulation of the femoral vessels/right internal jugular vein. The ascending aorta is occluded with a transthoracic aortic cross-clamp. Antegrade cardioplegia is delivered centrally into the aortic root through a cardioplegia vent catheter. By replicating conventional mitral valve repair done via an open sternotomy approach, the quality of mitral valve repair is ensured while providing the patients with advantages of less invasive surgery including shorter hospital stay, rapid recovery and return to normal activities, less blood transfusion, superior cosmesis and complete elimination of sternotomy-related morbidities such as deep sternal wound infection and sternal dehiscence. We reviewed the first consecutive 200 patients undergoing robotic mitral valve repair at Mayo Clinic Rochester between 24 January 2008 and 28 January 2011. Successful mitral valve repair was completed in all patients. There were no early (30-day) deaths. One patient suffered a stroke (0.5%). One patient required reoperation for bleeding (0.5%). Two patients (1%) required reoperation for recurrent mitral regurgitation. Twelve patients (6%) required transfusion of allogeneic blood products. We have noted a significant reduction in operative times and resource utilization over time.
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Affiliation(s)
- Khaled D Algarni
- King Saud University, Riyadh, Saudi Arabia Mayo Clinic, Rochester, MN, USA
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