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Bork FT, Boehmer AA, Zezyk C, Kaess BM, Ehrlich JR. Frame-rate reduction to reduce radiation dose for cardiac device implantation is safe. Heart Rhythm O2 2023; 4:427-432. [PMID: 37520019 PMCID: PMC10373156 DOI: 10.1016/j.hroo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background Radiation exposure to patient and surgeon during cardiac implantable electrical device (CIED) procedures remains a substantial health hazard to date. Advanced technical options for radiation dose reduction often pose considerable financial hurdles. We propose a near-zero cost, low-effort modification to a clinical x-ray system significantly reducing radiation dose during CIED implantation. Objective We aim to evaluate a reduced frame rate protocol in CIED implantation for complication rates and reduction in radiation exposure. Methods Starting May 2019, the frame rate during CIED implantations at our hospital was halved from 7.5 frames/s to 3.8 frames/s, and no further technical changes were made. During the following year, 264 patients were operated using this protocol and retrospectively compared with 231 cases implanted in the year before the protocol change, totaling 495 cases. Of these, 17%, 63%, and 19% were single-chamber, dual-chamber, or resynchronization devices, respectively. Incidence of complication prior to hospital discharge was considered the primary endpoint of the analysis. Radiation dose and procedural parameters were secondary endpoints. Results There was no increase in complications with the reduced frame rate protocol. Regression analysis further supported that the reduced frame rate radiation protocol was not associated with complication rates. Radiation exposure measured as dose area product was significantly reduced by ∼62% (median 369 [interquartile range 154-1207] cGy·cm2 via the reduced frame rate protocol vs median 970 [interquartile range 400-1906] cGy·cm2 with the standard frame rate; P < 0.01). Conclusion A reduction of frame rate during CIED implantation is safe in terms of complication incidence and effective in terms of reducing radiation exposure.
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Affiliation(s)
| | | | | | | | - Joachim R. Ehrlich
- Address reprint requests and correspondence: Dr Joachim R. Ehrlich, Department of Cardiology, St. Josefs-Hospital, Beethovenstraße 20, 65189 Wiesbaden, Germany.
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Cerny S, Oosterlinck W, Onan B, Singh S, Segers P, Bolcal C, Alhan C, Navarra E, Pettinari M, Van Praet F, De Praetere H, Vojacek J, Cebotaru T, Modi P, Doguet F, Franke U, Ouda A, Melly L, Malapert G, Labrousse L, Gianoli M, Agnino A, Philipsen T, Jansens JL, Folliguet T, Palmen M, Pereda D, Musumeci F, Suwalski P, Cathenis K, Van den Eynde J, Bonatti J. Robotic Cardiac Surgery in Europe: Status 2020. Front Cardiovasc Med 2022; 8:827515. [PMID: 35127877 PMCID: PMC8811127 DOI: 10.3389/fcvm.2021.827515] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background European surgeons were the first worldwide to use robotic techniques in cardiac surgery and major steps in procedure development were taken in Europe. After a hype in the early 2000s case numbers decreased but due to technological improvements renewed interest can be noted. We assessed the current activities and outcomes in robotically assisted cardiac surgery on the European continent. Methods Data were collected in an international anonymized registry of 26 European centers with a robotic cardiac surgery program. Results During a 4-year period (2016–2019), 2,563 procedures were carried out [30.0% female, 58.5 (15.4) years old, EuroSCORE II 1.56 (1.74)], including robotically assisted coronary bypass grafting (n = 1266, 49.4%), robotic mitral or tricuspid valve surgery (n = 945, 36.9%), isolated atrial septal defect closure (n = 225, 8.8%), left atrial myxoma resection (n = 54, 2.1%), and other procedures (n = 73, 2.8%). The number of procedures doubled during the study period (from n = 435 in 2016 to n = 923 in 2019). The mean cardiopulmonary bypass time in pump assisted cases was 148.6 (63.5) min and the myocardial ischemic time was 88.7 (46.1) min. Conversion to larger thoracic incisions was required in 56 cases (2.2%). Perioperative rates of revision for bleeding, stroke, and mortality were 56 (2.2%), 6 (0.2 %), and 27 (1.1%), respectively. Median postoperative hospital length of stay was 6.6 (6.6) days. Conclusion Robotic cardiac surgery case numbers in Europe are growing fast, including a large spectrum of procedures. Conversion rates are low and clinical outcomes are favorable, indicating safe conduct of these high-tech minimally invasive procedures.
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Affiliation(s)
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- *Correspondence: Wouter Oosterlinck
| | - Burak Onan
- Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Patrique Segers
- Maastricht University Medical Center, Maastricht, Netherlands
| | - Cengiz Bolcal
- Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | | | | | | | | | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | | | - Paul Modi
- Liverpool Heart and Chest, Liverpool, United Kingdom
| | | | | | - Ahmed Ouda
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | - Thierry Folliguet
- Henri MONDOR Hospital, Assitance Publique/Hopitaux de Paris, Paris, France
| | | | | | | | - Piotr Suwalski
- Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Jef Van den Eynde
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- Jef Van den Eynde
| | - Johannes Bonatti
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
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Hejjel L, Németh M, Melczer L, Kónyi A. Cardiac resynchronization therapy with intraoperative epicardial mapping via minithoracotomy: 10 years' experience. Pacing Clin Electrophysiol 2020; 44:101-109. [PMID: 33184900 PMCID: PMC7898599 DOI: 10.1111/pace.14123] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/19/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022]
Abstract
Background Cardiac resynchronization therapy (CRT) is considered an efficient method to improve the left ventricular (LV) dysfunction with left bundle branch block. However, coronary venous anatomy is not appropriate in about 10% of the cases; thus other alternatives, such as epicardial lead implantation via minithoracotomy are needed. Methods During the period 2007‐2017, a total of 57 patients were operated at our institute via left anterior minithoracotomy after an unsuccessful transvenous CRT. The best position of the LV epicardial electrode was determined by intraoperative epicardial mapping, that is locating the latest activation spot relative to the right ventricular (RV) electrode. The authors analyzed the survival by Kaplan‐Meier estimator with Tarone‐Ware equality test and multiple Cox regression analysis, the changes of the LV ejection fraction (LVEF) and dimensions, the development of the impedance and threshold of the LV epicardial electrode, the possible associations between the survival and intraoperative sensed RV‐LV activation delay. Results The intraoperative RV‐LV activation delay was 92.250 ± 26.538 milliseconds. There were no intraoperative complications except ventricular fibrillation in three patients. Within 30 days there were neither wound healing complications nor pocket hematoma. There was no significant difference in survival with regard to gender or etiology, but significantly better survival was found in the cohort with intraoperative sensed RV‐LV activation delay >86 milliseconds. The LVEF and dimensions improved following the operation and continued to be improved in the survivors. Conclusion CRT via minithoracotomy with epicardial mapping is a safe, efficient, simple, and reproducible second‐line alternative to the transvenous method.
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Affiliation(s)
- László Hejjel
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Marianna Németh
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - László Melczer
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Attila Kónyi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
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