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Palmen M, Navarra E, Bonatti J, Franke U, Cerny S, Musumeci F, Modi P, Singh S, Sandoval E, Pettinari M, Segers P, Gianoli M, van Praet F, de Praetere H, Vojacek J, Cebotaru T, Onan B, Bolcal C, Alhan C, Ouda A, Melly L, Malapert G, Labrousse L, Agnino A, Phillipsen T, Jansens JL, Folliguet T, Suwalski P, Cathenis K, Doguet F, Tomšič A, Oosterlinck W, Pereda D. Current state of the art and recommendations in robotic mitral valve surgery. Interact Cardiovasc Thorac Surg 2022; 35:ivac160. [PMID: 35748726 PMCID: PMC9724768 DOI: 10.1093/icvts/ivac160] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 09/29/2023] Open
Affiliation(s)
| | | | - Johannes Bonatti
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| | | | | | | | - Paul Modi
- Liverpool Heart and Chest, Liverpool, United Kingdom
| | | | | | | | - Patrique Segers
- Maastricht University Medical Center, Maastricht, Netherlands
| | | | | | | | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Burak Onan
- Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cengiz Bolcal
- Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | - Ahmed Ouda
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | - Thierry Folliguet
- Henri MONDOR Hospital, Assistance Publique Hopitaux de Paris, Creteil, France
| | - Piotr Suwalski
- Central Clinical Hospital of the Ministry of the Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Fabien Doguet
- Cardiovascular Institute Paris Sud, Private Hospital Jacques Cartier, Massy, France
| | - Anton Tomšič
- Leiden University Medical Centre, Leiden, Netherlands
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
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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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Bartakke AA, Carmona-Garcia P, Fuster-Gonzalez M, Reparaz-Vives X. Manejo anestésico en la cirugía de reparación valvular mitral. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Anastasiadis K, Antonitsis P, Deliopoulos A, Argiriadou H. From less invasive to minimal invasive extracorporeal circulation. J Thorac Dis 2021; 13:1909-1921. [PMID: 33841979 PMCID: PMC8024827 DOI: 10.21037/jtd-20-1830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Development of minimally invasive cardiac surgery (MICS) served the purpose of performing surgery while avoiding the surgical stress triggered by a full median sternotomy. Minimizing surgical trauma is associated with improved cosmesis and enhanced recovery leading to reduced morbidity. However, it has to be primarily appreciated that the extracorporeal circulation (ECC) stands for the basis of nearly all MICS procedures. With some fundamental modification and advancement in perfusion techniques, the use of ECC has become the enabling technology for the development of MICS. Less invasive cardiopulmonary bypass (CPB) techniques are based on remote cannulation and optimization of perfusion techniques with assisted venous drainage and use of centrifugal pump, so as to facilitate the demanding surgical maneuvers, rather than minimizing the invasiveness of the CPB. This is reflected in the increased duration of CPB required for MICS procedures. Minimal invasive Extracorporeal Circulation (MiECC) represents a major breakthrough in perfusion. It integrates all contemporary technological advancements that facilitate best applying cardiovascular physiology to intraoperative perfusion. Consequently, MiECC use translates to improved end-organ protection and clinical outcome, as evidenced in multiple clinical trials and meta-analyses. MICS performed with MiECC provides the basis for developing a multidisciplinary intraoperative strategy towards a "more physiologic" cardiac surgery by combining small surgical trauma with minimum body's physiology derangement. Integration of MiECC can advance MICS from non-full sternotomy for selected patients to a "more physiologic" surgery, which represents the real face of modern cardiac surgery in the transcatheter era.
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Affiliation(s)
| | | | | | - Helena Argiriadou
- Cardiothoracic Department, AHEPA University Hospital, Thessaloniki, Greece
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Abstract
Due to its potential benefits and increased patient satisfaction minimal invasive cardiac surgery (MICS) is rapidly gaining in popularity. These procedures are not without challenges and require careful planning, pre-operative patient assessment and excellent intraoperative communication. Assessment of patient suitability for MICS by a multi-disciplinary team during pre-operative workup is desirable. MICS requires additional skills that many might not consider to be part of the standard cardiac anesthetic toolkit. Anesthetists involved in MICS need not only be highly skilled in performing transesophageal echocardiography (TEE) but need to be proficient in multimodal analgesia, including locoregional or neuroaxial techniques. MICS procedures tend to cause more postoperative pain than standard median sternotomies do, and patients need analgesic management more in keeping with thoracic operations. Ultrasound guided peripheral regional anesthesia techniques like serratus anterior block can offer an advantage over neuroaxial techniques in patients on anti-platelet therapy or anticoagulation with low molecular weight or unfractionated heparin The article reviews the salient points pertaining to pre-operative assessment and suitability, intraoperative process and postoperative management of minimally invasive cardiac procedures in the operating theatre as well as the catheterization lab. Special emphasis is given to anesthetic management and analgesia techniques.
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Affiliation(s)
- Alexander White
- Senior Fellow in Anaesthetics and Intensive Care, The Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Chinmay Patvardhan
- Consultant in Anaesthetics and Intensive Care, The Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Florian Falter
- Consultant in Anaesthetics and Intensive Care, The Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Maj G, Regesta T, Campanella A, Cavozza C, Parodi G, Audo A. Optimal Management of Patients Treated With Minimally Invasive Cardiac Surgery in the Era of Enhanced Recovery After Surgery and Fast-Track Protocols: A Narrative Review. J Cardiothorac Vasc Anesth 2021; 36:766-775. [PMID: 33840614 DOI: 10.1053/j.jvca.2021.02.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Use of minimally invasive cardiac surgery (MICS) is increasing, but to exert its maximum effect on patient outcomes, MICS must be coupled with improved perioperative management, including the Enhanced Recovery after Surgery (ERAS) and fast-track protocols. This study aimed to evaluate the impact of ERAS and fast track in this context. DESIGN NARRATIVE REVIEW: The authors performed a narrative review that included patients treated with MICS and patients treated with the ERAS/fast-track protocols in the MEDLINE/PubMed database. The keywords ERAS and fast-track were combined with the following key words: minimally invasive cardiac surgery OR robotic cardiac surgery OR minimally invasive mitral surgery OR minimally invasive aortic surgery. RESULTS Overall, the authors selected six studies in which either the ERAS or fast-track protocol was applied. The reported adherence to ERAS protocols was high, and neither protocol-related complications nor in-hospital mortality occurred. Patients managed based on ERAS had significantly lower postoperative pain scores, fewer rates of blood transfusions, and shorter hospital and intensive care unit stays compared with those who received standard management. All ERAS patients were managed safely, with early extubation. Similarly, fast-track cardiac surgery, with immediate postprocedure extubation and early transfer to the ward, was shown to be safe, with no increased morbidity or mortality. CONCLUSION Use of standardized ERAS and fast-track protocols seems to be feasible and safe in the context of MICS, with improved outcomes. Both ERAS and fast track allow for a faster return to full functional status while minimizing perioperative complications.
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Affiliation(s)
- Giulia Maj
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | - Tommaso Regesta
- Department of Cardiac Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Campanella
- Department of Cardiac Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Corrado Cavozza
- Department of Cardiac Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giovanni Parodi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Audo
- Department of Cardiac Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Antico M, Sasazawa F, Wu L, Jaiprakash A, Roberts J, Crawford R, Pandey AK, Fontanarosa D. Ultrasound guidance in minimally invasive robotic procedures. Med Image Anal 2019; 54:149-167. [DOI: 10.1016/j.media.2019.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/01/2019] [Accepted: 01/09/2019] [Indexed: 12/20/2022]
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Tamadon I, Soldani G, Dario P, Menciassi A. Novel Robotic Approach for Minimally Invasive Aortic Heart Valve Surgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3656-3659. [PMID: 30441166 DOI: 10.1109/embc.2018.8513309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aortic heart valve replacement is a major surgical intervention, traditionally requiring a large thoracotomy. However, current advances in Minimally Invasive Surgery and Surgical Robotics can offer the possibility to perform the intervention through a narrow mini thoracotomy. The presented surgical robot and proposed surgical scenario aims to provide a highly controllable means for efficiently conducting valve replacement by endoscopic vision. The robot, consisting of a series of joints, is a cable actuated manipulator for reaching the operative site and delivering the valve at the required position. The robot is equipped with endoscopic cameras (to find the hinge points) and three stabilizing flaps (to stabilize the manipulator) for guarantying the proper valve placement. The manipulator is validated by experimental results of flaps' force and camera visions in artificial vessels.
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Vohra HA, Ahmed EM, Meyer A, Kempfert J. Knowledge transfer and quality control in minimally invasive aortic valve replacement. Eur J Cardiothorac Surg 2018; 53:ii9-ii13. [DOI: 10.1093/ejcts/ezy077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/01/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Hunaid A Vohra
- Bristol Heart Institute, University Hospitals, Bristol, UK
| | | | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
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Kruklitis R, French K, Cangelosi MJ, Kovitz KL. Investing in New Technology in Pulmonary Medicine: Navigating the Tortuous Path to Success. Chest 2017. [PMID: 28642108 DOI: 10.1016/j.chest.2017.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The introduction of new technologies offers the promise to advance medicine. This occurs alongside improved efforts to control costs of health care by hospital administrators, the Centers for Medicare & Medicaid Services' (CMS) pivot to value programs, and commercial payers' efforts to reduce reimbursement. These trends present a challenge for the pulmonologist, among others, who must navigate increasingly complex and highly scrutinized evaluation processes used to secure new technology (NT). Health-care providers are turning toward value assessments while simultaneously tasked with the mission of offering state of the art technologies and services. Pulmonologists desiring NT are thus faced with increased scrutiny in their evaluation of costs and clinical data to support investments. Consideration of this scrutiny and further evidence to temper the evaluation will improve the likelihood of adoption and patient access to clinically impactful technology. The identification of this evidence may provide a comprehensive view of the clinical and economic benefits of such technologies to both administrators and pulmonary clinicians. It is imperative that all parties involved in the decision process work collaboratively to deploy value added and clinically impactful technologies. Although a physician group might invest in such NT, the capital required often leads such decisions to a larger organization such as a hospital, health-care system, or privately owned entity. This article aims to provide a framework for pulmonary clinicians to better understand the processes that purchasers use to evaluate NT, the pressures that influence their consideration, and what resources may be leveraged toward success.
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Affiliation(s)
- Robert Kruklitis
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA
| | | | | | - Kevin L Kovitz
- Department of Medicine, the University of Illinois at Chicago College of Medicine, Chicago, IL.
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Hollatz A, Balkhy HH, Chaney MA, Neuburger PJ, Gerlach RM, Guy TS. Robotic Mitral Valve Repair With Right Ventricular Pacing-Induced Ventricular Fibrillatory Arrest. J Cardiothorac Vasc Anesth 2016; 31:345-353. [PMID: 28277246 DOI: 10.1053/j.jvca.2016.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Hollatz
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Husam H Balkhy
- Robotic and Minimally Invasive Cardiac Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, Division of Cardiothoracic Anesthesiology, NYU School of Medicine, NYU Langone Medical Center, New York, NY
| | - Rebecca M Gerlach
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - T Sloane Guy
- Robotic Cardiac Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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The "Spacemaker", a New Device for Minimally Invasive Cardiothoracic Surgery: An Evaluation and Feasibility Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:241-7; discussion 247. [PMID: 26368032 DOI: 10.1097/imi.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our aim was to evaluate a new inflatable lung retractor, the "Spacemaker", and its efficacy in facilitating minimally invasive cardiothoracic surgery without the need of one lung ventilation or carbon dioxide overpressure insufflation. METHODS The device was tested in 12 anesthetized pigs (90-100 kg) placed on standard endotracheal ventilation. The device was introduced into the right or left side of the chest, depending on the intended procedure to be performed, via a 3-cm incision in the fifth intercostal space. A total of seven animals were used to evaluate hemodynamic and respiratory response to the device, whereas another five animals were used to assess the feasibility of a variety of minimally invasive cardiothoracic surgical procedures. RESULTS Introduction was easy and unhindered. The device was inflated up to 0.6 bar, thereby pushing the lung tissue gently away cranially, posteriorly, and caudally without interfering with pulmonary function or resulting in respiratory compromise. In addition, hemodynamics remained stable throughout the experiments. Different closed-chest surgical procedures such as left atrial appendage exclusion, pulmonary vein exposure, pacemaker lead placement, and endoscopic stabilization for coronary surgery, were successfully performed. Removal was quick and complete in all cases, and lung tissue showed no remnant atelectasis. CONCLUSIONS The "Spacemaker" may represent a reliable alternative to current conventional techniques to facilitate minimally invasive cardiothoracic surgery. Further research is warranted to confirm the effectiveness and the safety of this device and to optimize the model before its use in humans and its introduction into clinical practice.
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Kesner KL, Chaney MA, Dupont FW, Vernick W, Ramachandran S, Leff JD. CASE 2-2016 Complete Failure of Mechanical Mitral Valve Opening on Weaning From Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2015; 30:237-44. [PMID: 26475391 DOI: 10.1053/j.jvca.2015.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Kimberly L Kesner
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL.
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Frank W Dupont
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - William Vernick
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Jonathan D Leff
- Department of Anesthesiology(,) Montefiore Medical Center, Bronx, NY
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Lozekoot PW, Gelsomino S, Kwant PB, Parise O, Matteucci F, de Jong MM, Maessen JG, Gründeman PF. The “Spacemaker”, a New Device for Minimally Invasive Cardiothoracic Surgery: An Evaluation and Feasibility Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Sandro Gelsomino
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul B. Kwant
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Orlando Parise
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Jos G. Maessen
- Maastricht University Medical Center, Maastricht, The Netherlands
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Minimally invasive robotically assisted surgical resection of left atrial endocardial papillary fibroelastomas. J Thorac Cardiovasc Surg 2014; 148:3247-9. [DOI: 10.1016/j.jtcvs.2014.06.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/29/2014] [Indexed: 11/23/2022]
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