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Piekarski F, Rohner M, Monsefi N, Bakhtiary F, Velten M. Anesthesia for Minimal Invasive Cardiac Surgery: The Bonn Heart Center Protocol. J Clin Med 2024; 13:3939. [PMID: 38999504 DOI: 10.3390/jcm13133939] [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: 06/12/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
The development and adoption of minimally invasive techniques has revolutionized various surgical disciplines and has also been introduced into cardiac surgery, offering patients less invasive options with reduced trauma and faster recovery time compared to traditional open-heart procedures with sternotomy. This article provides a comprehensive overview of the anesthesiologic management for minimally invasive cardiac surgery (MICS), focusing on preoperative assessment, intraoperative anesthesia techniques, and postoperative care protocols. Anesthesia induction and airway management strategies are tailored to each patient's needs, with meticulous attention to maintaining hemodynamic stability and ensuring adequate ventilation. Intraoperative monitoring, including transesophageal echocardiography (TEE), processed EEG monitoring, and near-infrared spectroscopy (NIRS), facilitates real-time assessment of cardiac and cerebral perfusion, as well as function, optimizing patient safety and improving outcomes. The peripheral cannulation techniques for cardiopulmonary bypass (CPB) initiation are described, highlighting the importance of cannula placement to minimize tissue as well as vessel trauma and optimize perfusion. This article also discusses specific MICS procedures, detailing anesthetic considerations and surgical techniques. The perioperative care of patients undergoing MICS requires a multidisciplinary approach including surgeons, perfusionists, and anesthesiologists adhering to standardized treatment protocols and pathways. By leveraging advanced monitoring techniques and tailored anesthetic protocols, clinicians can optimize patient outcomes and promote early extubation and enhanced recovery.
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Affiliation(s)
- Florian Piekarski
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany
| | - Marc Rohner
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany
| | - Nadejda Monsefi
- Department of Cardiac Surgery, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, 53127 Bonn, Germany
- Department of Anesthesiology and Pain Management, Division of Cardiovascular and Thoracic Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Helms F, Deniz E, Krüger H, Zubarevich A, Schmitto JD, Poyanmehr R, Hinteregger M, Martens A, Weymann A, Ruhparwar A, Schmack B, Popov AF. Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch. J Clin Med 2024; 13:3274. [PMID: 38892985 PMCID: PMC11172865 DOI: 10.3390/jcm13113274] [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: 04/26/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: In recent years, minimally invasive approaches have been used with increasing frequency, even for more complex aortic procedures. However, evidence on the practicability and safety of expanding minimally invasive techniques from isolated operations of the ascending aorta towards more complex operations such as the hemiarch replacement is still scarce to date. Methods: A total of 86 patients undergoing elective surgical replacement of the ascending aorta with (n = 40) or without (n = 46) concomitant proximal aortic arch replacement between 2009 and 2023 were analyzed in a retrospective single-center analysis. Groups were compared regarding operation times, intra- and postoperative complications and long-term survival. Results: Operation times and ventilation times were significantly longer in the hemiarch replacement group. Despite this, no statistically significant differences between the two groups were observed for the duration of the ICU and hospital stay and postoperative complication rates. At ten-year follow-up, overall survival was 82.6% after isolated ascending aorta replacement and 86.3% after hemiarch replacement (p = 0.441). Conclusions: Expanding the indication for minimally invasive aortic surgery towards the proximal aortic arch resulted in comparable postoperative complication rates, length of hospital stay and overall long-term survival compared to the well-established minimally invasive isolated supracommissural ascending aorta replacement.
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Affiliation(s)
- Florian Helms
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ezin Deniz
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Heike Krüger
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Alina Zubarevich
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jan Dieter Schmitto
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Reza Poyanmehr
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Hinteregger
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andreas Martens
- Clinic for Cardiac Surgery, University Clinic Oldenburg, 26129 Oldenburg, Germany
| | - Alexander Weymann
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Arjang Ruhparwar
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bastian Schmack
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Aron-Frederik Popov
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Staromłyński J, Kowalówka A, Gocoł R, Hudziak D, Żurawska M, Nowak W, Pasierski M, Sarnowski W, Smoczyński R, Bartczak M, Brączkowski J, Sadecka S, Drobiński D, Deja M, Szymański P, Suwalski P, Kowalewski M. Comparative Analysis of Long-Term Outcomes in Valve-Sparing Aortic Root Reimplantation: Full Sternotomy versus Mini-Sternotomy Approach. J Clin Med 2024; 13:2692. [PMID: 38731222 PMCID: PMC11084568 DOI: 10.3390/jcm13092692] [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: 02/29/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively (p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter (p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality (p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome.
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Affiliation(s)
- Jakub Staromłyński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Adam Kowalówka
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Radosław Gocoł
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Małgorzata Żurawska
- Clinical Cardiology Department, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.Ż.); (P.S.)
| | - Wojciech Nowak
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Michał Pasierski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Wojciech Sarnowski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Radosław Smoczyński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Maciej Bartczak
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Jakub Brączkowski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Sabina Sadecka
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Dominik Drobiński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Marek Deja
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Szymański
- Clinical Cardiology Department, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.Ż.); (P.S.)
| | - Piotr Suwalski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Mariusz Kowalewski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 90127 Palermo, Italy
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Akin AN, Yildiz Y, Alver S, Ciftci B. Continuous serratus posterior superior intercostal plane block for postoperative analgesia management in the patient who underwent right atrial mass excision: a case report. BMC Anesthesiol 2024; 24:159. [PMID: 38664657 PMCID: PMC11044298 DOI: 10.1186/s12871-024-02535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
Serratus posterior intercostal plane block (SPSIPB) is a novel periparavertebral block. It provides anterolateral posterior chest wall analgesia. It is an interfascial plane block, performed under ultrasound guidance, and the visualization of landmarks is easy. It is performed deep into the serratus posterior superior muscle at the level of the third rib. Until now, there have been case reports about the usage of single-shot SPSIPB, but there are no reports about the usage of the block catheterization technique of SPSIPB. Continuous infusion from a catheter of interfascial plane blocks is important for postoperative analgesia management after painful surgeries such as thoracic and cardiac surgeries. Thus, we performed SPSIPB catheterization in a patient who underwent right atrial mass excision with minimally invasive thoracotomy surgery. Here, we present our successful analgesic experience with continuous SPSIPB in this case report.
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Affiliation(s)
- Ayşe Nurmen Akin
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Mega Medipol University Hospital, No: 1 Bağcılar, Istanbul, 34040, Turkey
| | - Yahya Yildiz
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Mega Medipol University Hospital, No: 1 Bağcılar, Istanbul, 34040, Turkey
| | - Selcuk Alver
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Mega Medipol University Hospital, No: 1 Bağcılar, Istanbul, 34040, Turkey
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Mega Medipol University Hospital, No: 1 Bağcılar, Istanbul, 34040, Turkey.
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Ilcheva L, Häussler A, Cholubek M, Ntinopoulos V, Odavic D, Dushaj S, Rodriguez Cetina Biefer H, Dzemali O. Thirteen Years of Impactful, Minimally Invasive Coronary Surgery: Short- and Long-Term Results for Single and Multi-Vessel Disease. J Clin Med 2024; 13:761. [PMID: 38337455 PMCID: PMC10856352 DOI: 10.3390/jcm13030761] [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: 12/16/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES Minimally invasive coronary surgery (MICS) via lateral thoracotomy is a less invasive alternative to the traditional median full sternotomy approach for coronary surgery. This study investigates its effectiveness for short- and long-term revascularization in cases of single and multi-vessel diseases. METHODS A thorough examination was performed on the databases of two cardiac surgery programs, focusing on patients who underwent minimally invasive coronary bypass grafting procedures between 2010 and 2023. The study involved patients who underwent either minimally invasive direct coronary artery bypass grafting (MIDCAB) for the revascularization of left anterior descending (LAD) artery stenosis or minimally invasive multi-vessel coronary artery bypass grafting (MICSCABG). Our assessment criteria included in-hospital mortality, long-term mortality, and freedom from reoperations due to failed aortocoronary bypass grafts post-surgery. Additionally, we evaluated significant in-hospital complications as secondary endpoints. RESULTS A total of 315 consecutive patients were identified between 2010 and 2023 (MIDCAB 271 vs. MICSCABG 44). Conversion to median sternotomy (MS) occurred in eight patients (2.5%). The 30-day all-cause mortality was 1.3% (n = 4). Postoperative AF was the most common complication postoperatively (n = 26, 8.5%). Five patients were reoperated for bleeding (1.6%), and myocardial infarction (MI) happened in four patients (1.3%). The mean follow-up time was six years (±4 years). All-cause mortality was 10.3% (n = 30), with only five (1.7%) patients having a confirmed cardiac cause. The reoperation rate due to graft failure or the progression of aortocoronary disease was 1.4% (n = 4). CONCLUSIONS Despite the complexity of the MICS approach, the results of our study support the safety and effectiveness of this procedure with low rates of mortality, morbidity, and conversion for both single and multi-vessel bypass surgeries. These results underscore further the necessity to implement such programs to benefit patients.
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Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (L.I.); (A.H.); (M.C.); (V.N.); (D.O.); (S.D.); (H.R.C.B.)
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (L.I.); (A.H.); (M.C.); (V.N.); (D.O.); (S.D.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, Birmensdorferstrasse 497, 8055 Zurich, Switzerland
| | - Magdalena Cholubek
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (L.I.); (A.H.); (M.C.); (V.N.); (D.O.); (S.D.); (H.R.C.B.)
| | - Vasileios Ntinopoulos
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (L.I.); (A.H.); (M.C.); (V.N.); (D.O.); (S.D.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, Birmensdorferstrasse 497, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (L.I.); (A.H.); (M.C.); (V.N.); (D.O.); (S.D.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, Birmensdorferstrasse 497, 8055 Zurich, Switzerland
| | - Stak Dushaj
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (L.I.); (A.H.); (M.C.); (V.N.); (D.O.); (S.D.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, Birmensdorferstrasse 497, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (L.I.); (A.H.); (M.C.); (V.N.); (D.O.); (S.D.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, Birmensdorferstrasse 497, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (L.I.); (A.H.); (M.C.); (V.N.); (D.O.); (S.D.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, Birmensdorferstrasse 497, 8055 Zurich, Switzerland
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Wisniewski AM, Young SD, Do-Nguyen CC, Hawkins RB, Romano MP, Teman NR, Ailawadi G. Impact of Frailty in Patients Undergoing Minimally Invasive Mitral Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:64-71. [PMID: 38284330 DOI: 10.1177/15569845231222315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Psoas muscle size is a reliable marker of sarcopenia and frailty that correlates with adverse outcomes after cardiac surgery. However, its use in mitral and minimally invasive cardiac surgery is lacking. We sought to determine whether frailty, as measured by psoas muscle index, increases surgical risk for minimally invasive mitral valve surgery. METHODS Patients undergoing isolated minimally invasive mitral surgery via right minithoracotomy were identified. Patients who underwent maze, tricuspid intervention, and those who were emergent were excluded. Total psoas muscle area was calculated using the average cross-sectional area at the L3 vertebra on computed tomography scan and indexed to body surface area. Sarcopenia was defined as <25th gender-specific percentile. Patients were stratified by sarcopenia status and outcomes compared. RESULTS Of 287 total patients, 192 patients met inclusion criteria. Sarcopenic patients were 6 years older (66 vs 60 years, P = 0.01), had lower preoperative albumin levels (4.0 vs 4.3 g/dL, P < 0.001), and had higher Society of Thoracic Surgeons risk of morbidity/mortality (13.1% vs 9.0%, P = 0.003). Operative major morbidity or mortality was 6.4% versus 5.5% (P = 0.824), while the 1-year mortality rate was 2.1% versus 0% (P = 0.08). After risk adjustment, psoas index did not predict operative morbidity or mortality. However, sarcopenia was associated with higher odds of readmission (odds ratio = 0.74, P = 0.02). CONCLUSIONS Contrary to other cardiac operations, for patients undergoing isolated minimally invasive mitral valve surgery, sarcopenia was not associated with increased perioperative risk except for higher readmission rates. Minimally invasive surgical approaches should be strongly considered as the approach of choice in frail patients.
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Affiliation(s)
- Alex M Wisniewski
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Steven D Young
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Chi Chi Do-Nguyen
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew P Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D, Rodriguez Cetina Biefer H, Dzemali O. Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery. J Clin Med 2023; 12:7210. [PMID: 38068262 PMCID: PMC10707549 DOI: 10.3390/jcm12237210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 06/26/2024] Open
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.
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Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
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Jaquet O, Gos L, Amabili P, Donneau AF, Mendes MA, Bonhomme V, Tchana-Sato V, Hans GA. On-table Extubation After Minimally Invasive Cardiac Surgery: A Retrospective Observational Pilot Study. J Cardiothorac Vasc Anesth 2023; 37:2244-2251. [PMID: 37612202 DOI: 10.1053/j.jvca.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To assess the safety of "on-table" extubation after minimally-invasive heart valve surgery. DESIGN A single-center retrospective observational study. SETTING At a tertiary referral academic hospital. PARTICIPANTS Patients who underwent nonemergent isolated heart valve surgery through a minithoracotomy approach between January 2016 and August 2021. INTERVENTION All patients were treated by 1 of the 6 cardiac anesthesiologists of the hospital. Only some of them practiced "on-table" extubation, and the outcome of patients extubated "on-table" was compared to those extubated in the intensive care unit (ICU). MEASUREMENT AND MAIN RESULTS The primary outcome was the occurrence of any postoperative respiratory complication during the entire hospital stay. Secondary outcomes included the use of inotropes and vasopressors, de novo atrial fibrillation, and lengths of stay in the ICU and the hospital. A total of 294 patients met inclusion criteria, of whom 186 (63%) were extubated "on-table." Cardiopulmonary bypass duration was significantly longer, and moderate intraoperative hypothermia was significantly more frequent in patients extubated in the ICU. After adjustment for these confounders and for the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II using a multivariate logistic model, no association was found between the extubation strategy and postoperative pulmonary complications (adjusted odds ratio = 0.84; 95% CI = 0.40-1.77; p = 0.64). "On-table" extubation was associated with a lower risk of postoperative pneumonia and fewer vasopressors requirements. CONCLUSION "On-table" extubation was not associated with an increased incidence of respiratory complications. A randomized controlled trial is warranted to confirm these results and determine whether "on-table" extubation offers additional benefits.
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Affiliation(s)
- Océane Jaquet
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium.
| | - Laura Gos
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Philippe Amabili
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | | | - Manuel Azevedo Mendes
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium; Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Vincent Tchana-Sato
- Department of Cardiovascular Surgery, Liege University Hospital, Liege, Belgium
| | - Grégory A Hans
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
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9
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Reuthebuch O, Stein A, Koechlin L, Gahl B, Berdajs D, Santer D, Eckstein F. Five-Year Survival of Patients Treated with Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Compared with the General Swiss Population. Thorac Cardiovasc Surg 2023. [PMID: 37044119 DOI: 10.1055/s-0043-1768035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND To evaluate the midterm follow-up and 5-year survival outcome of the minimally invasive direct coronary artery bypass (MIDCAB) procedure compared with the survival of the general Swiss population. METHODS Retrospective study on preoperative data, intraoperative data, and postoperative outcome of patients who underwent MIDCAB surgery between June 2010 and February 2019. To assess validity of this surgical therapy, outcomes were compared with survival data of a gender- and age-matched cohort of the general Swiss population taken from the database of the Swiss Federal Statistical Office. RESULTS A total of 88 patients were included. Median (interquartile range [IQR[) age was 66 (56-75) years, and 27% (n = 24) were female. The median (IQR) length of the in-hospital stay was 7 (6-8) days. No postoperative stroke occurred. The 30-day mortality was 1.1% (n = 1). Reintervention for failed left internal mammary artery was needed in 1.1% (n = 1). The median (IQR) ejection fraction was 58% (47-60) preoperatively and remained stable during follow-up. The median (IQR) follow-up period was 3 (1.1-5.2) years. Five years postoperatively, 83% (confidence interval, 69-91) of the patients were alive, showing an overlap with the range of survival of the matched subcohort of the general Swiss population (range, 84-100%). CONCLUSION Though suffering from coronary heart disease, patients after MIDCAB show almost equal survival rates as an equivalent subcohort corresponding to the general Swiss population matched on age and gender. Thus, our data show this treatment to be safe and beneficial.
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Affiliation(s)
- Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Alina Stein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
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10
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Vinzant NJ, Christensen JM, Yalamuri SM, Smith MM, Nuttall GA, Arghami A, LeMahieu AM, Schroeder DR, Mauermann WJ, Ritter MJ. Pectoral Fascial Plane Versus Paravertebral Blocks for Minimally Invasive Mitral Valve Surgery Analgesia. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00099-X. [PMID: 36948910 DOI: 10.1053/j.jvca.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVES This study examined the postoperative analgesic efficacy of single-injection pectoral fascial plane (PECS) II blocks compared to paravertebral blocks for elective robotic mitral valve surgery. DESIGN A single-center retrospective study that reported patient and procedural characteristics, postoperative pain scores, and postoperative opioid use for patients undergoing robotic mitral valve surgery. SETTING This investigation was performed at a large quaternary referral center. PARTICIPANTS Adult patients (age ≥18) admitted to the authors' hospital from January 1, 2016, to August 14, 2020, for elective robotic mitral valve repair who received either a paravertebral or PECS II block for postoperative analgesia. INTERVENTIONS Patients received an ultrasound-guided, unilateral paravertebral or PECS II nerve block. MEASUREMENTS AND MAIN RESULTS One hundred twenty-three patients received a PECS II block, and 190 patients received a paravertebral block during the study period. The primary outcome measures were average postoperative pain scores and cumulative opioid use. Secondary outcomes included hospital and intensive care unit lengths of stay, need for reoperation, need for antiemetics, surgical wound infection, and atrial fibrillation incidence. Patients receiving the PECS II block required significantly fewer opioids in the immediate postoperative period than the paravertebral block group, and had comparable postoperative pain scores. No increase in adverse outcomes was noted for either group. CONCLUSIONS The PECS II block is a safe and highly effective option for regional analgesia for robotic mitral valve surgery, with demonstrated efficacy comparable to the paravertebral block.
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Affiliation(s)
- Nathan J Vinzant
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jon M Christensen
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Suraj M Yalamuri
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Gregory A Nuttall
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Allison M LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Darrell R Schroeder
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - William J Mauermann
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Matthew J Ritter
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
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11
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Lim MH, Lee CH, Ju MH, Je HG. Impact of Sarcopenia on Outcomes of Minimally Invasive Cardiac Surgery. Semin Thorac Cardiovasc Surg 2023; 35:77-85. [PMID: 34780924 DOI: 10.1053/j.semtcvs.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 01/11/2023]
Abstract
Sarcopenia is an objective marker of poor outcome following cardiac surgery through median sternotomy. However, the clinical impact of sarcopenia after minimally invasive cardiac surgery (MICS) has not been well established. This study aimed to analyze the influence of sarcopenia on the early and late outcomes following MICS. We retrospectively examined 1248 patients who underwent MICS via right mini-thoracotomy or upper sternotomy between February 2009 and April 2020. Patients older than 65 years who underwent preoperative computed tomography were enrolled. Sarcopenia was defined as the lowest sex-specific quartile of the body surface area adjusted psoas muscle area. The early operative and late survival outcomes were compared, and the predictor of late composite outcome was analyzed using Cox proportional regression model. Early and late composite outcomes in both groups were also compared. A total of 367 patients were classified into the sarcopenia (n = 92) or non-sarcopenia (n = 275) group. Patients in the sarcopenia group were older, and had lower preoperative hemoglobin and albumin levels. They had higher estimated surgical mortality, but similar early mortality and major morbidity. The survival and late composite outcome were comparable between the two groups. Sarcopenia was neither an independent predictor of late death nor a composite outcome in the multivariable model. After MICS, patients with sarcopenia displayed comparable perioperative outcomes and survival. The clinical impact of sarcopenia on postoperative outcomes might be alleviated by MICS and early recovery protocol after MICS. MICS could be a reasonable approach for elderly patients with sarcopenia.
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Affiliation(s)
- Mi Hee Lim
- Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Chee-Hoon Lee
- Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Min Ho Ju
- Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea
| | - Hyung Gon Je
- Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea.
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12
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Barbosa RCS, Mendes PM. A Comprehensive Review on Photoacoustic-Based Devices for Biomedical Applications. SENSORS (BASEL, SWITZERLAND) 2022; 22:9541. [PMID: 36502258 PMCID: PMC9736954 DOI: 10.3390/s22239541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
The photoacoustic effect is an emerging technology that has sparked significant interest in the research field since an acoustic wave can be produced simply by the incidence of light on a material or tissue. This phenomenon has been extensively investigated, not only to perform photoacoustic imaging but also to develop highly miniaturized ultrasound probes that can provide biologically meaningful information. Therefore, this review aims to outline the materials and their fabrication process that can be employed as photoacoustic targets, both biological and non-biological, and report the main components' features to achieve a certain performance. When designing a device, it is of utmost importance to model it at an early stage for a deeper understanding and to ease the optimization process. As such, throughout this article, the different methods already implemented to model the photoacoustic effect are introduced, as well as the advantages and drawbacks inherent in each approach. However, some remaining challenges are still faced when developing such a system regarding its fabrication, modeling, and characterization, which are also discussed.
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13
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Hawkins AD, Strobel RJ, Mehaffey JH, Hawkins RB, Rotar EP, Young AM, Yarboro LT, Yount K, Ailawadi G, Joseph M, Quader M, Teman NR. Operating Room Versus Intensive Care Unit Extubation Within 6 Hours After On-Pump Cardiac Surgery: Early Results and Hospital Costs. Semin Thorac Cardiovasc Surg 2022; 36:195-208. [PMID: 36460133 PMCID: PMC10225475 DOI: 10.1053/j.semtcvs.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 12/02/2022]
Abstract
Time-directed extubation (fast-track) protocols may decrease length of stay and cost but data on operating room (OR) extubation is limited. The objective of this study was to compare the outcomes of extubation in the OR versus fast-track extubation within 6 hours of leaving the operating room. Patients undergoing nonemergent STS index cases (2011-2021) who were extubated within 6 hours were identified from a regional STS quality collaborative. Patients were stratified by extubation in the OR versus fast track. Propensity score matching (1:n) was performed to balance baseline differences. Of the 24,962 patients, 498 were extubated in the OR. After matching, 487 OR extubation cases and 899 fast track cases were well balanced. The rate of reintubation was higher for patients extubated in the OR [21/487 (4.3%) vs 16/899 (1.8%), P = 0.008] as was the incidence of reoperation for bleeding [12/487 (2.5%) vs 8/899 (0.9%), P = 0.03]. There was no significant difference in the rate of any reoperation [16/487 (3.3%) vs 15/899 (1.6%), P = 0.06] or operative mortality [4/487 (0.8%) vs 6/899 (0.6%), P = 0.7]. OR extubation was associated with shorter hospital length of stay (5.6 vs 6.2 days, P < 0.001) and lower total cost of admission ($29,602 vs $31,565 P < 0.001). OR extubation is associated with a higher postoperative risk of reintubation and reoperation due to bleeding, but lower resource utilization.Future research exploring predictors of extubation readiness may be required prior to widespread adoption of this practice.
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Affiliation(s)
- Andrew D Hawkins
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia
| | - Raymond J Strobel
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Evan P Rotar
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia
| | - Andrew M Young
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia
| | - Leora T Yarboro
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia
| | - Kenan Yount
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mark Joseph
- Carilion Clinic Cardiothoracic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Mohammed Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Virginia
| | - Nicholas R Teman
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Virginia.
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14
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Barua R, Das S, RoyChowdhury A, Datta P. Simulation and experimental investigation of the surgical needle deflection model during the rotational and steady insertion process. Int J Artif Organs 2022; 46:40-51. [DOI: 10.1177/03913988221136154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Needle insertion is executed in numerous medical and brachytherapy events. Exact needle insertion into inhomogeneous soft biological tissue is of useful importance due to its significance in clinical diagnosis (especially percutaneous) and treatments. The surgical needles used in such processes can deflect during the percutaneous process. Needle deflecting which affects needle — soft tissue interface and needle controllability have a crucial role in establishment precision. In this paper, we have analyzed a mechanics-based model both rotational and non-rotational needle insertion, and studied the deflection phenomenon in both insertion cases, we validated it with a real-time nonlinear Dassault Systèmes® ABAQUS simulation model. For definite contact force, the maximum the contact stiffness was, the minimum it inserted, the cohesive surface model was used to investigate the needle insertion analysis, where the fracture point was defined by a failure strain and with the help of the in, the fully failed components would be removed. Using living tissue comparable PVA gel materials, the needle insertion force model is developed from insertion experimentations with the help of two different processes (rotational and non-rotational needle insertion). In a rotational needle, deflection is less than in a non-rotational needle. The preliminary insertion was observed in the rotational needle at 1.261 mm (experiment), and 1.538 mm (simulation), and for non-rotational needle insertion, the initial insertion was noticed at 1.756 mm (experiment) and 1.982 mm (simulation). The main aim of this study is to navigate the surgical needle in an accurate way to reduce the erroneousness for a clinical diagnosis like anesthesia, brachytherapy, biopsy, and modern microsurgery operation.
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Affiliation(s)
- Ranjit Barua
- Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
| | - Surajit Das
- R. G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Amit RoyChowdhury
- Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
| | - Pallab Datta
- National Institute of Pharmaceutical Education and Research-Kolkata, West Bengal, India
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15
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Impact of minimally invasive mitral valve surgery on sexual dysfunction in male patients. J Cardiothorac Surg 2022; 17:77. [PMID: 35421997 PMCID: PMC9008948 DOI: 10.1186/s13019-022-01814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Sexual dysfunction after cardiac surgery can seriously affect patients’ quality of life, but the impact of cardiac surgery on sexual function has long been neglected. Compared with conventional cardiac surgery, minimally invasive cardiac surgery has the advantages of aesthetic appearance and no disruption of the sternal structure, which can greatly improve the patient's quality of life. However, studies focusing on the effects of minimally invasive mitral valve surgery (MIMVS) on sexual function have not been reported. The objective of this research was to investigate the effects of totally endoscopic mitral valve surgery on health-related quality of life and sexual function in male patients and to provide possible recommendations. Methods Patients who underwent median sternotomy or totally endoscopic mitral valve surgery at our institution from January 2019 to December 2020 were selected using an electronic medical record system. Data were collected by questionnaires, including the MOS 36-item short-form health survey and the International Erectile Function Questionnaire. Results There were 156 male patients who participated in our study. Of these, 112 patients completed all questionnaires. Forty-five patients (40.18%) developed postoperative sexual dysfunction, including 15 patients (29.41%) in the MIMVS group and 30 patients (49.18%) in the conventional MVS group, indicating that the incidence of sexual dysfunction could be reduced by MIMVS and that the MIMVS group scored better on the International Erectile Function Questionnaire (P < 0.05). On the evaluation of health-related quality of life, the MIMVS group scored better than the MVS group on the mental health and bodily pain subscales of the MOS 36-item short-form health survey. In addition, our study showed that postoperative sexual dysfunction was associated with physical functioning and mental health. Conclusions In our study, totally endoscopic mitral valve surgery had less adverse effects on sexual function in male patients than conventional mitral valve surgery. In terms of health-related quality of life, totally endoscopic mitral valve surgery was superior to conventional surgery. Patients who opt for totally endoscopic mitral valve surgery may have a more satisfying and healthier sexual life than those who undergo conventional mitral valve surgery.
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16
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Thornton S, Kang L, Nellis J, Andersen ND, Haney J, Turek J. Comparison of median sternotomy and left anterior mini-incision for pulmonary valve replacement following primary tetralogy of Fallot repair. Cardiol Young 2022; 33:1-5. [PMID: 35067250 DOI: 10.1017/s1047951122000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Pulmonary insufficiency requiring reintervention frequently occurs after primary tetralogy of Fallot repair. Repeat interventions present a challenge for both the surgeon and patient. We compare a minimally invasive, 5 cm left anterior mini-incision to redo median sternotomy for pulmonary valve replacement in tetralogy of Fallot patients. METHODS Following Internal Review Board approval, we conducted a single institution retrospective review of patients with tetralogy of Fallot who underwent pulmonary valve replacement via redo median sternotomy or left anterior mini-incision between 13 July, 2016 and 6 March, 2020. RESULTS Twenty-three patients underwent pulmonary valve replacement following primary tetralogy of Fallot repair between March 2016 and March 2020. Twelve patients received a redo-median sternotomy from March 2016 to August 2018. Left anterior mini-incision was first offered in August of 2018 and was chosen by all eleven patients thereafter. The two groups had similar baseline characteristics including preoperative pulmonary valve dysfunction. Early trends suggest a longer cardiopulmonary bypass time for patients who received left anterior mini-incisions. Other outcomes were comparable, including operative times, blood product requirements, residual pulmonary valve dysfunction, postoperative pain, narcotic requirements, ICU length of stay, total length of stay, and postoperative complications. CONCLUSIONS In patients who have previously undergone primary repairs of tetralogy of Fallot, outcomes for pulmonary valve replacement via left anterior mini-incision are comparable to those via redo median sternotomy.
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Affiliation(s)
- Steven Thornton
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Lillian Kang
- Congenital Heart Surgery Research & Training Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Joseph Nellis
- Congenital Heart Surgery Research & Training Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Nicholas D Andersen
- Congenital Heart Surgery Research & Training Laboratory, Duke University Medical Center, Durham, NC, USA
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John Haney
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joseph Turek
- Congenital Heart Surgery Research & Training Laboratory, Duke University Medical Center, Durham, NC, USA
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
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Persistent and acute postoperative pain after cardiac surgery with anterolateral thoracotomy or median sternotomy: A prospective observational study. J Clin Anesth 2021; 77:110577. [PMID: 34799229 DOI: 10.1016/j.jclinane.2021.110577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The primary objective of this study was to compare the association between cardiac surgical approach (thoracotomy vs. sternotomy) and incidence of persistent postoperative pain at 3 months. Secondary objectives were the incidence and intensity of persistent pain at 6 and 12 months, acute postoperative pain, analgesic requirement and its side effects. DESIGN Single-center, prospective, observational study. Recruitment between December 2017 and August 2018. SETTING Perioperative care at university-affiliated tertiary care centre. PATIENTS 202 adults scheduled for cardiac surgery. Patients with chronic pain or behavioural disorder were excluded. INTERVENTIONS Thoracotomy (n = 106) and sternotomy (n = 96). MEASUREMENTS Pain scores and pain medication requirements from extubation until hospital discharge. Persistent postoperative pain was assessed using a telephone questionnaire. MAIN RESULTS Incidence and intensity of pain was not significantly different between thoracotomy or sternotomy either in the short- or in the long-term follow-up. Incidence of persistent postoperative pain showed no differences between groups (30.2 vs 22.9% at 3 months (p = 0.297), 10.4 vs 7.3% at 6 months (p = 0.364) and 7.5 vs 7.3% at 12 months (p = 0.518) in thoracotomy and sternotomy group). A significant decrease of pain incidence was observed between 3 and 6 months (p < 0.001) but not between 6 and 12 months (p = 0.259) in both groups. ANOVA of repeated measures adjusted for confounding variable showed a decrease of acute pain intensity over time (p = 0.001) with no difference between groups (p = 0.145). Acute pain medication requirements were not different between the groups (p = 0.237 for piritramide and p = 0.743 for oxycodone) with no difference in their side effects. CONCLUSIONS Our study showed no difference in short- or long-term pain in patients undergoing anterolateral thoracotomy or median sternotomy. Both groups showed a decrease in persistent postoperative pain incidence between 3 and 6 months without any significant changes at 12 months.
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Hou B, Zhao R, Wang D, Wang W, Zhao Z, Sun X, Qian X, Yu C. Outcomes of the Valve-Sparing Root Replacement Procedure with Partial Upper Sternotomy. J Cardiovasc Dev Dis 2021; 8:jcdd8110154. [PMID: 34821707 PMCID: PMC8618798 DOI: 10.3390/jcdd8110154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022] Open
Abstract
Due to better postoperative convalescence and quality of life, experienced centers focus on minimally invasive surgical techniques and approaches, but this approach is not routinely performed for valve-sparing root replacement procedures. The purpose of this study was to assess the safety and feasibility of valve-sparing root replacement via partial upper sternotomy. Between January 2016 and April 2021, 269 patients underwent a valve-sparing root replacement procedure, and partial upper sternotomy was performed in 52 patients. The clinical outcomes of the partial upper sternotomy (PUS) and complete sternotomy (CS) groups, including mortality, degree of aortic insufficiency, blood loss and consumption of blood products, postoperative complications, and hospitalization expenses, were compared. The Kaplan–Meier method was used to assess the degree of aortic regurgitation. Propensity score matching was performed as a sensitivity analysis. There was only one in-hospital death (in the CS group, p = 1) and no postoperative moderate to severe aortic insufficiency in either group. The blood loss and consumption of blood products in the PUS group were also lower than in the CS group, especially for plasma use. Regarding the need for re-exploration because of bleeding, acute kidney injury, pericardial pleural effusion, drainage volume within the first 24 h, mechanical ventilation time, and arrhythmia, the two groups were comparable. Patients in the CS group showed a longer ICU time (74.20 ± 47.21 vs. 50.9 30.16 h, p = 0.001) and higher hospitalization expenses (135,649.52 ± 29,992.21 vs. 123,380.15 ± 27,062.82 yuan, p < 0.001). None of the patients died or reoperated during the follow-up. Freedom from moderate or severe aortic insufficiency remained comparable after matching (p = 0.97). Minimally invasive valve-sparing aortic replacement via partial upper sternotomy can be safely performed in selected patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Cuntao Yu
- Correspondence: or ; Tel.: +86-1088392345
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Lauck SB, Baron SJ, Irish W, Borregaard B, Moore KA, Gunnarsson CL, Clancy S, Wood DA, Thourani VH, Webb JG, Wijeysundera HC. Temporal Changes in Mortality After Transcatheter and Surgical Aortic Valve Replacement: Retrospective Analysis of US Medicare Patients (2012-2019). J Am Heart Assoc 2021; 10:e021748. [PMID: 34581191 PMCID: PMC8751862 DOI: 10.1161/jaha.120.021748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The treatment of aortic stenosis is evolving rapidly. Pace of change in the care of patients undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) differs. We sought to determine differences in temporal changes in 30‐day mortality, 30‐day readmission, and length of stay after TAVR and SAVR. Methods and Results We conducted a retrospective cohort study of patients treated in the United States between 2012 and 2019 using data from the Medicare Data Set Analytic File 100% Fee for Service database. We included consecutive patients enrolled in Medicare Parts A and B and aged ≥65 years who had SAVR or transfemoral TAVR. We defined 3 study cohorts, including all SAVR, isolated SAVR (without concomitant procedures), and elective isolated SAVR and TAVR. The primary end point was 30‐day mortality; secondary end points were 30‐day readmission and length of stay. Statistical models controlled for patient demographics, frailty measured by the Hospital Frailty Risk Score, and comorbidities measured by the Elixhauser Comorbidity Index (ECI). Cox proportional hazard models were developed with TAVR versus SAVR as the main covariates with a 2‐way interaction term with index year. We repeated these analyses restricted to full aortic valve replacement hospitals offering both SAVR and TAVR. The main study cohort included 245 269 patients with SAVR and 188 580 patients with TAVR, with mean±SD ages 74.3±6.0 years and 80.7±6.9 years, respectively, and 36.5% and 46.2% female patients, respectively. Patients with TAVR had higher ECI scores (6.4±3.6 versus 4.4±3) and were more frail (55.4% versus 33.5%). Total aortic valve replacement volumes increased 61% during the 7‐year span; TAVR volumes surpassed SAVR in 2017. The magnitude of mortality benefit associated with TAVR increased until 2016 in the main cohort (2012: hazard ratio [HR], 0.76 [95% CI, 0.67–0.86]; 2016: HR, 0.39 [95% CI, 0.36–0.43]); although TAVR continued to have lower mortality rates from 2017 to 2019, the magnitude of benefit over SAVR was attenuated. A similar pattern was seen with readmission, with a lower risk of readmission from 2012 to 2016 for patients with TAVR (2012: HR, 0.68 [95% CI, 0.63–0.73]; 2016: HR, 0.43 [95% CI, 0.41–0.45]) followed by a lesser difference from 2017 to 2019. Year over year, TAVR was associated with increasingly shorter lengths of stay compared with SAVR (2012: HR, 1.91 [95% CI, 1.84–1.98]; 2019: HR, 5.34 [95% CI, 5.22–5.45]). These results were consistent in full aortic valve replacement hospitals. Conclusions The rate of improvement in TAVR outpaced SAVR until 2016, with the recent presence of U‐shaped phenomena suggesting a narrowing gap between outcomes. Future longitudinal research is needed to determine the long‐term implications of lowering risk profiles across treatment options to guide case selection and clinical care.
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Affiliation(s)
- Sandra B Lauck
- Centre for Heart Valve Innovation University of British Columbia Vancouver Canada
| | - Suzanne J Baron
- Department of Cardiology Lahey Hospital & Medical Center Burlington MA
| | - William Irish
- Department of Public Health Brody School of Medicine East Carolina University Greenville NC
| | - Britt Borregaard
- Department of Cardiology Odense University Hospital Odense Denmark
| | | | | | | | - David A Wood
- Centre for Heart Valve Innovation University of British Columbia Vancouver Canada
| | | | - John G Webb
- Centre for Heart Valve Innovation University of British Columbia Vancouver Canada
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Nguyen HC, Pham DT. Totally endoscopic resection of epicardial cardiac haemangioma under on-pump beating heart. Ann Med Surg (Lond) 2021; 69:102838. [PMID: 34527243 PMCID: PMC8433115 DOI: 10.1016/j.amsu.2021.102838] [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: 08/18/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Cardiac haemangioma (CH) is an extremely rare type of benign heart tumor, with prevalence only 2.8% of all primary cardiac tumors. The symptoms of tumor are often nonspecific. Preoperative screening and diagnosis are based on imaging examinations. Radical surgical resection is indicated in symptomatic patients. Case presentation We report on a case of an incidentally found tumor located on the right-sided epicardium that was successfully removed with the totally endoscopic surgery (TES) and the concomitant use of cardiopulmonary bypass (CPB). Discussion Excision of these tumors has been described through a median sternotomy approach. In recent years, TES has grown in popularity with many advantages. On the other hand, on-pump beating-heart (ON–BH) technique has been appreciated as a superior myocardial preservation method. The combination of these procedure provides clinical benefits and patient preferences. Conclusion Totally endoscopic resection of CH under ON-BH is a safe, effective procedure, which can be adopted in similar cases. Surgical resection of cardiac haemangioma is the first-line treatment. Minimally invasive cardiac surgery has gradually replaced the sternotomy approach. On-pump beating-heart technique provides significantly lower morbidity and mortality. Totally endoscopic resection of tumor under a beating-heart is safe, effective.
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Affiliation(s)
- Huu Cong Nguyen
- Cardiovascular Center, E Hospital, 89 Tran Cung Street, Cau giay District, Hanoi, Viet Nam
| | - Dat Thanh Pham
- Cardiovascular Center, E Hospital, 89 Tran Cung Street, Cau giay District, Hanoi, Viet Nam
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Pirola S, Montisci A, Mastroiacovo G, Jaber EA, Fileccia D, Bonomi A, Pappalardo F, Bisleri G, Polvani G. Right Ventricular Function After Minimally Invasive Mitral Valve Surgery. J Cardiothorac Vasc Anesth 2021; 36:1073-1080. [PMID: 34629238 DOI: 10.1053/j.jvca.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/12/2021] [Accepted: 08/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after cardiac surgery. Minimally invasive mitral valve surgery (MIMVS) increasingly is being performed. The authors aim was to evaluate postoperative RV function in patients who underwent MIMVS versus traditional mitral valve surgery. DESIGN Six hundred seventy-five patients who underwent elective isolated mitral valve surgery at Centro Cardiologico Monzino from January 2016 to December 2019 were analyzed. After 1:1 propensity score matching, 60 patients were identified in the MIMVS (study group A) and 58 patients in the median sternotomy (control group B) and compared. SETTING A university-affiliated scientific institute, monocentric. PARTICIPANTS Patients. INTERVENTIONS Mitral valve surgery. MEASUREMENTS AND MAIN RESULTS No in-hospital deaths occurred. Aortic cross-clamp time (102 [87.5-119] v 83 [61-109] minutes, p = 0.0001), cardiopulmonary bypass duration (161.5 [142.5-181] v 105.5 [74-134] minutes, p < 0.0001) and intensive care unit stay (47 [44-72] v 45 [40-47] hours, p = 0.0015) were significantly longer in group A. The tricuspid annular plane systolic excursion was not different between group A and group B neither postoperatively (15 ± 3 v 14 ± 4 mm, p = 0.1) nor at three-month follow-up (18 ± 4 v 15 ± 3 mm, p = 0.3). No differences in peak postoperative lactates, inotropic score, central venous pressure, and pulmonary artery pulsatility index were observed. The length of hospital stay was significantly shorter in the minimally invasive group (ten [eight-13] v 12 [ten-17], p = 0.006). CONCLUSION The authors study showed that the surgical strategy had no significant impact on postoperative RV function after mitral valve surgery.
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Affiliation(s)
- Sergio Pirola
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Andrea Montisci
- Division of Cardiothoracic Intensive Care, ASST Spedali Civili, Brescia, Italy.
| | - Giorgio Mastroiacovo
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Emad Al Jaber
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Daniele Fileccia
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Alice Bonomi
- Department of Statistics, Centro Cardiologico Monzino, Milan, Italy
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, St. Micheal's Hospital, University of Toronto, Toronto (ON), Canada
| | - Gianluca Polvani
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy; Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
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Rayner TA, Harrison S, Rival P, Mahoney DE, Caputo M, Angelini GD, Savović J, Vohra HA. Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 57:8-17. [PMID: 31209468 DOI: 10.1093/ejcts/ezz177] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 01/28/2023] Open
Abstract
Limited uptake of minimally invasive surgery (MIS) of the aorta hinders assessment of its efficacy compared to median sternotomy (MS). The objective of this systematic review is to compare operative and perioperative outcomes for MIS versus MS. Online databases Medline, EMBASE, Cochrane Library and Web of Science were searched from inception until July 2018. Both randomized and observational studies of patients undergoing aortic root, ascending aorta or aortic arch surgery by MIS versus MS were eligible for inclusion. Primary outcomes were 30-day mortality, reoperation for bleeding, perioperative renal impairment and neurological events. Intraoperative and postoperative timing measures were also evaluated. Thirteen observational studies were included comparing 1101 MIS and 1405 MS patients. The overall quality of evidence was very low for all outcomes. Mortality and the incidence of stroke were similar between the 2 cohorts. Meta-analysis demonstrated increased length of cardiopulmonary bypass (CPB) time for patients undergoing MS [standardized mean difference 0.36, 95% confidence interval (CI) 0.15-0.58; P = 0.001]. Patients receiving MS spent more time in hospital (standardized mean difference 0.30, 95% CI 0.17-0.43; P < 0.001) and intensive care (standardized mean difference 0.17, 95% CI 0.06-0.27; P < 0.001). Reoperation for bleeding (risk ratio 1.51, 95% CI 1.06-2.17; P = 0.024) and renal impairment (risk ratio 1.97, 95% CI 1.12-3.46; P = 0.019) were also greater for MS patients. There was substantial heterogeneity in meta-analyses for CPB and aortic cross-clamp timing outcomes. MIS may be associated with improved early clinical outcomes compared to MS, but the quality of the evidence is very low. Randomized evidence is needed to confirm these findings.
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Affiliation(s)
- Tom A Rayner
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sean Harrison
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Rival
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Hearth Institute, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Hearth Institute, Bristol, UK
| | - Jelena Savović
- Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Hearth Institute, Bristol, UK
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Pajares MA, Margarit JA, García-Camacho C, García-Suarez J, Mateo E, Castaño M, López Forte C, López Menéndez J, Gómez M, Soto MJ, Veiras S, Martín E, Castaño B, López Palanca S, Gabaldón T, Acosta J, Fernández Cruz J, Fernández López AR, García M, Hernández Acuña C, Moreno J, Osseyran F, Vives M, Pradas C, Aguilar EM, Bel Mínguez AM, Bustamante-Munguira J, Gutiérrez E, Llorens R, Galán J, Blanco J, Vicente R. Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP). REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:183-231. [PMID: 33541733 DOI: 10.1016/j.redar.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 01/28/2023]
Abstract
The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.
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Affiliation(s)
- M A Pajares
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | - J A Margarit
- Servicio de Cirugía Cardiaca, Hospital Universitari de La Ribera, Valencia, España
| | - C García-Camacho
- Unidad de Perfusión del Servicio de Cirugía Cardiaca, Hospital Universitario Puerta del Mar,, Cádiz, España
| | - J García-Suarez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro, Madrid, España
| | - E Mateo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario de Valencia, Valencia, España
| | - M Castaño
- Servicio de Cirugía Cardiaca, Complejo Asistencial Universitario de León, León, España
| | - C López Forte
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - J López Menéndez
- Servicio de Cirugía Cardiaca, Hospital Ramón y Cajal, Madrid, España
| | - M Gómez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de La Ribera, Valencia, España
| | - M J Soto
- Unidad de Perfusión, Servicio de Cirugía Cardiaca, Hospital Universitari de La Ribera, Valencia, España
| | - S Veiras
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España
| | - E Martín
- Servicio de Cirugía Cardiaca, Complejo Asistencial Universitario de León, León, España
| | - B Castaño
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario de Toledo, Toledo, España
| | - S López Palanca
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario de Valencia, Valencia, España
| | - T Gabaldón
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario de Valencia, Valencia, España
| | - J Acosta
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J Fernández Cruz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de La Ribera, Valencia, España
| | - A R Fernández López
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Virgen Macarena, Sevilla, España
| | - M García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - C Hernández Acuña
- Servicio de Cirugía Cardiaca, Hospital Universitari de La Ribera, Valencia, España
| | - J Moreno
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario de Valencia, Valencia, España
| | - F Osseyran
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - M Vives
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari Dr. Josep Trueta, Girona, España
| | - C Pradas
- Servicio de Cirugía Cardiaca, Hospital Universitari Dr. Josep Trueta, Girona, España
| | - E M Aguilar
- Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Madrid, España
| | - A M Bel Mínguez
- Servicio de Cirugía Cardiaca, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - J Bustamante-Munguira
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - E Gutiérrez
- Servicio de Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R Llorens
- Servicio de Cirugía Cardiovascular, Hospiten Rambla, Santa Cruz de Tenerife, España
| | - J Galán
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Blanco
- Unidad de Perfusión, Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - R Vicente
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, España
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Margarit JA, Pajares MA, García-Camacho C, Castaño-Ruiz M, Gómez M, García-Suárez J, Soto-Viudez MJ, López-Menéndez J, Martín-Gutiérrez E, Blanco-Morillo J, Mateo E, Hernández-Acuña C, Vives M, Llorens R, Fernández-Cruz J, Acosta J, Pradas-Irún C, García M, Aguilar-Blanco EM, Castaño B, López S, Bel A, Gabaldón T, Fernández-López AR, Gutiérrez-Carretero E, López-Forte C, Moreno J, Galán J, Osseyran F, Bustamante-Munguira J, Veiras S, Vicente R. Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP). CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Rajput NK, Kalangi TKV, Andappan A, Swain AK. MICS CABG: a single-center experience of the first 100 cases. Indian J Thorac Cardiovasc Surg 2021; 37:16-26. [PMID: 33442204 PMCID: PMC7778645 DOI: 10.1007/s12055-020-01048-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To study the learning curve and outcomes of the first 100 cases of minimally invasive cardiac surgery (MICS) coronary artery bypass grafting (CABG) performed at our center. METHODS From January 2017 to November 2019, a total of 100 patients underwent CABG via left anterior thoracotomy approach. We have studied the operative times within the MICS CABG patients to analyze our learning curve. We also studied the postoperative outcomes and compared these with those of patients who underwent sternotomy during the same period. RESULTS The mean age was 59.33 ± 9.95 (range 37-82) years. The numbers of males and females were 72 and 28 respectively. The preoperative average ejection fraction (EF) was 51.08 ± 9.75%. All these patients underwent CABG via left thoracotomy approach, after satisfying the exclusion criteria. All patients received left internal mammary artery (LIMA) to left anterior descending (LAD) as a standard graft, with the radial artery and saphenous vein being the next alternative conduits. The average length of the incision was 6.06 ± 0.45 cm. Only 2 cases were done on pump. The average number of grafts per patient was 2.33 ± 0.92. The mean operative time was 132.40 ± 11.56 min. The mean duration of ventilation was 4.79 ± 1.90 h and average intensive care unit (ICU) stay was 2.62 ± 0.84 days. There was one conversion and no mortalities in our study. We had analyzed our operative times and noticed a significant reduction after the first 20 cases, which was our learning curve. CONCLUSION MICS CABG can be performed for multivessel disease with the same comfort as for a single or a double vessel disease, once the learning curve has been achieved. Only significant difference from the sternotomy approach was noted in the longer operative times for MICS CABG during the learning curve, and not thereafter. Significant benefits of MICS over sternotomy were noticed in the immediate postoperative parameters like duration of ventilation, mean drainage, postoperative pain, ICU stay, and hospital stay, with no difference in postoperative adverse events.
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Affiliation(s)
- Nitin Kumar Rajput
- Department of Cardiothoracic Surgery, NHMMI Narayana Superspeciality Hospital, Raipur, Chhattishgarh 492001 India
| | - Tej Kumar Varma Kalangi
- Department of Cardiothoracic Surgery, NHMMI Narayana Superspeciality Hospital, Raipur, Chhattishgarh 492001 India
| | - Arun Andappan
- Department of Anaesthesiology and Critical Care, NHMMI Narayana Superspeciality Hospital, Raipur, Chhattishgarh 492001 India
| | - Alok Kumar Swain
- Department of Anaesthesiology and Critical Care, NHMMI Narayana Superspeciality Hospital, Raipur, Chhattishgarh 492001 India
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Acute Cardiac Care – an Interdisciplinary Approach. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2020. [DOI: 10.2478/jce-2020-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lee CH, Kwon Y, Park SJ, Lee JW, Kim JB. Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegic solutions in minimally invasive cardiac surgery. J Thorac Cardiovasc Surg 2020; 164:e161-e171. [PMID: 33487412 DOI: 10.1016/j.jtcvs.2020.11.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We examined the safety and efficacy of del Nido cardioplegic solution compared with histidine-tryptophan-ketoglutarate cardioplegic solution in minimally invasive cardiac surgery. METHODS Patients who underwent minimally invasive cardiac surgery using del Nido or histidine-tryptophan-ketoglutarate from 2015 to 2019 were enrolled. Various clinical outcomes were compared between the groups. Postoperative laboratory findings including the levels of electrolytes, cardiac enzymes (creatine kinase-MB and troponin I), and serial blood lactate were also measured and compared. Based on 28 baseline covariates, propensity score matching was performed to reduce selection bias. RESULTS Among 766 patients, del Nido and histidine-tryptophan-ketoglutarate were used in 330 patients (43.1%) and 436 patients (56.9%), respectively. There were no significant intergroup differences in postoperative clinical outcomes and early adverse outcomes among 228 pairs of propensity score-matched patients. Immediate postoperative sodium levels were within the normal range in both groups without a significant difference (P = .50). However, peak creatine kinase-MB (median, 31.9 vs 37.7 ng/mL, P = .026) and troponin I (6.9 vs 9.1 ng/mL, P = .014) levels were significantly lower in the del Nido group. Linear regression analysis revealed a significant association between the peak cardiac enzyme levels and the cardiac ischemic time depending on the cardioplegia type, with lower cardiac isoenzymes for del Nido over histidine-tryptophan-ketoglutarate (P < .001) until the crossover point at the cardiac ischemic time over 100 minutes. CONCLUSIONS In comparison with histidine-tryptophan-ketoglutarate solution, del Nido solution seems to have acceptable safety and efficacy with good myocardial protection in minimally invasive cardiac surgery. Further studies focusing on complex surgeries requiring longer cardiac ischemic time are needed.
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Affiliation(s)
- Chee-Hoon Lee
- Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Seoul, South Korea
| | - Youngkern Kwon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
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Liu J, Wei P, Ma J, Fang L, Chen Z, Cao Z, Liu F, Liu Y, Tan T, Wu H, Huang H, Chen J, Zhuang J, Xie B, Guo H. Propensity-matched analysis of two port approach versus three port approach for totally thoracoscopic mitral valve replacement. J Thorac Dis 2020; 12:5986-5995. [PMID: 33209431 PMCID: PMC7656324 DOI: 10.21037/jtd-20-2901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND To objectively evaluate the feasibility, safety, effectiveness and short-term outcome of totally thoracoscopic mitral valve replacement via two port approach, we conducted a retrospective study comparing two port approach with three port approach for mitral valve replacement. METHODS Data for all thoracoscopic mitral valve replacement were analyzed from Guangdong Cardiovascular Institute between January 1, 2016 and December 31, 2017. To account for selection bias between two port approach and three approach, one-to-one propensity score caliper matching without replacement was performed. The clinical data of the two groups were collected, including preoperative cardiac function, operative data, postoperative complications, and short-term outcome. RESULTS A total of 330 patients who underwent totally thoracoscopic mitral replacement via two port or three port from January 1, 2016 to December 31, 2017 were enrolled (two-port group: n=103; three-port group: n=227). Propensity score matching resulted in 71 matched pairs with improved balance post matching in baseline covariates. The baseline differences between two groups were eliminated (P>0.05 for all baseline variables). The cardiopulmonary bypass time (min) (154.27±57.02 vs. 142.68±51.33 P=0.183) and the aortic cross-clamp time (min) (106.99±106.98 vs. 90.16±31.63 P=0.206) in the two-port group were not significantly different from those in the three-port group. No significant difference was observed between the two groups in mechanical ventilation time, duration of intensive care unit stay, or amount of postoperative chest drainage. No perioperative death or re-exploration for bleeding was found in either group. As for other postoperative complications, two groups had the similar rate of lung infection lung infection (1.41% vs. 1.33% P=1.000) or acute renal failure (1.41% vs. 1.41% P=1.000). CONCLUSIONS No significant differences in cardiopulmonary bypass time, aortic cross-clamp time, overall operative time, perioperative mortality, or complications were observed between two-port and three-port totally thoracoscopic mitral valve replacement. Two-port totally thoracoscopic mitral valve replacement is a safe, effective, and feasible procedure for mitral valve replacement.
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Affiliation(s)
- Jian Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Peijian Wei
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Jiexu Ma
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Liangzheng Fang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Zhao Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Zhongming Cao
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Fangzhou Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Yanjun Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Tong Tan
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hongxiang Wu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huanlei Huang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Bin Xie
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huiming Guo
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
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Dexmedetomidine Improves Lung Function by Promoting Inflammation Resolution in Patients Undergoing Totally Thoracoscopic Cardiac Surgery. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8638301. [PMID: 32963704 PMCID: PMC7495214 DOI: 10.1155/2020/8638301] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 02/08/2023]
Abstract
Objective Totally thoracoscopic cardiac surgery under cardiopulmonary bypass combined with one-lung ventilation has been identified as the trend in cardiac surgery. The aim of this study was to examine the effects of the selective α 2 adrenergic receptor agonist dexmedetomidine on the pulmonary function of patients who underwent mitral valve surgery using the totally thoracoscopic technique. Methods Fifty-seven patients who underwent thoracoscopic mitral valve surgery between July 2019 and December 2019 were selected. The patients were randomly divided into the control (Con) group (n = 28) and the dexmedetomidine (DEX) group (n = 29) using the random number table method. Arterial blood gas analyses were performed, and the oxygenation (PaO2/FiO2) and respiratory indexes (P(A-a)O/PaO2) were calculated 5 min after tracheal intubation (T1), 2 h after operation (T2), 6 h after operation (T3), and 24 h after operation (T4). Moreover, the serum cytokines interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) were detected using the enzyme-linked immunosorbent method at all time points. Chest radiography was performed 24 h after surgery. Peripheral blood samples were collected before and after the operation for a complete hemogram. Additionally, the procalcitonin concentration was measured and recorded when the patients were transported to the intensive care unit (ICU). The postoperative extubation time, length of ICU stay, and pulmonary infection rate were also recorded. Results Inflammatory reaction after surgery was evident. However, the inflammatory cytokines IL-6, TNF-α, and ICAM-1 in the DEX group were lower than those in the Con group after surgery (T2 to T4; P < 0.05). Neutrophil counts and procalcitonin concentration were higher in the Con group than in the DEX group (P < 0.05). In addition, in the DEX group, pulmonary exudation on chest radiography was lower, and pulmonary function, as shown by an increase in oxidation index and decrease in the respiratory index, improved after surgery (P < 0.05). Moreover, the duration of mechanical ventilation in the Con group was 3.4 h longer than that in the DEX group. Conclusion Dexmedetomidine has a protective effect on pulmonary function in patients undergoing mitral valve surgery using a totally video-assisted thoracoscopic technique, which may be related to a reduction in the concentration of inflammatory cytokines in the early perioperative period.
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Single Upper Hemisternotomy Is Safe as a Routine Approach for Total Arch Replacement: Reply. Ann Thorac Surg 2020; 111:378-379. [PMID: 32835754 DOI: 10.1016/j.athoracsur.2020.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/20/2022]
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31
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Dieberg G, Nick L P, Melissa J P, Nicola K, Neil A S. Author's Reply to Amiri et al.- Meta-analysis of vitamin D supplementation on endothelial function: Methodological limitations. Nutr Metab Cardiovasc Dis 2020; 30:1406-1407. [PMID: 32595084 DOI: 10.1016/j.numecd.2020.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Gudrun Dieberg
- School of Science and Technology, University of New England, Armidale, NSW 2351, Australia.
| | - Pincombe Nick L
- School of Science and Technology, University of New England, Armidale, NSW 2351, Australia
| | - Pearson Melissa J
- School of Science and Technology, University of New England, Armidale, NSW 2351, Australia
| | - King Nicola
- School of Biomedical Sciences, Faculty of Medicine and Dentistry, University of Plymouth, Drake's Circus, Plymouth, PL4 8AA, UK
| | - Smart Neil A
- School of Science and Technology, University of New England, Armidale, NSW 2351, Australia
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Rosol Z, Vasudevan A, Sawhney R, Hebeler RF, Tecson KM, Stoler RC. Hybrid intervention approach to coronary artery and valvular heart disease. Proc (Bayl Univ Med Cent) 2020; 33:520-523. [PMID: 33100519 DOI: 10.1080/08998280.2020.1784638] [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: 10/23/2022] Open
Abstract
Coronary angiography is used to assess the burden of coronary artery disease prior to surgical valve repair/replacement and often leads to concomitant bypass and valve surgery. We sought to evaluate outcomes of an alternative, hybrid approach involving percutaneous coronary intervention (PCI) and valve surgery, assessing the rate of stent thrombosis as a primary outcome. We reviewed charts of consecutive patients who underwent planned PCI prior to surgical valve repair/replacement by a single surgeon from January 2008 to December 2016. We calculated rates of surgical complication, duration of dual antiplatelet therapy (DAPT) prior to surgery, and rates of stent thrombosis and in-stent restenosis. Twenty-four patients were included in this study. Surgery was performed a median of 52.5 days following PCI. DAPT was withheld an average of 8 days before and resumed an average of 4 days after surgery. Ninety-two percent of surgeries were minimally invasive. There were no bleeding complications, stent thromboses, or restenosis events. All patients survived the 1-year follow-up. For patients with mixed coronary and valvular heart disease, a heart team approach involving preoperative PCI followed by staged minimally invasive valvular surgery appears to be safe and warrants further exploration.
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Affiliation(s)
- Zachary Rosol
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Anupama Vasudevan
- Baylor Heart and Vascular Institute, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
| | - Rahul Sawhney
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Robert F Hebeler
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
| | - Robert C Stoler
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
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Minimally invasive direct CABG versus off-pump CABG: Can less be more. Hellenic J Cardiol 2020; 61:125-126. [PMID: 32580018 DOI: 10.1016/j.hjc.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022] Open
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34
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Jiang H, Liu Y, Yang Z, Ge Y, Li L, Wang H. Total Arch Replacement via Single Upper-Hemisternotomy Approach in Patients With Type A Dissection. Ann Thorac Surg 2020; 109:1394-1399. [DOI: 10.1016/j.athoracsur.2019.08.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/05/2019] [Accepted: 08/26/2019] [Indexed: 11/30/2022]
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35
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Spadaccio C, Hu H, Li C, Qiao Z, Ge Y, Tie Z, Zhu J, Moon MR, Danton M, Sun L, Gaudino MF. Thoracic aortic surgery: status and upcoming novelties. Minerva Cardioangiol 2020; 68:518-531. [PMID: 32319269 DOI: 10.23736/s0026-4725.20.05263-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Several novel technological developments and surgical approaches have characterized the field of aortic surgery in the recent decade. The progressive introduction of endovascular procedures, minimally invasive surgical techniques and hybrid approaches have changed the practice in aortic surgery and generated new trends and questions. Also, the advancements in the manufacturing of tissue engineered vascular grafts as substitutes for aortic replacements are enlightening new avenues in the treatment of aortic disease. This review will provide an overview of the current novel perspectives, debates and trends in major thoracic aortic surgery.
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Affiliation(s)
- Cristiano Spadaccio
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK - .,Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK - .,Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China -
| | - Haiou Hu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Chengnan Li
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Zhiyu Qiao
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Yipeng Ge
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Zheng Tie
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Marc R Moon
- School of Medicine, Washington University, St Louis, MI, USA
| | - Mark Danton
- Department of Cardiac Surgery, Scottish Pediatric Cardiac Services, Royal Hospital for Children, Glasgow, UK
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Mario F Gaudino
- Department of Cardiothoracic Surgery Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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Influence of a Biocompatible Hydrophilic Needle Surface Coating on a Puncture Biopsy Process for Biomedical Applications. COATINGS 2020. [DOI: 10.3390/coatings10020178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A puncture biopsy is a widely used, minimally invasive surgery process. During the needle insertion process, the needle body is always in direct contact with a biological soft tissue. Tissue adhesion and different degrees of tissue damage occur frequently. Optimization of the needle surface, and especially the lubrication of the needle surface, can deal with these problems efficiently. Therefore, in this paper, a biocompatible hydrophilic coating was applied onto the surface of a needle to improve the surface quality of the needle surface. Further, a simplified finite element model of insertion was established, and extracorporeal insertion experiments were used to verify the accuracy of the model. Then, by analyzing a simulation model of a coated needle and a conventional needle, the influence of the application of the coated needle on the insertion process was obtained. It can be seen from the results that the coating application relieved the force on the needle and the soft tissue during the insertion process and could significantly reduce friction during the insertion process. At the same time, the deformation of biological soft tissue was reduced, and the adhesion situation between the needle and tissue improved, which optimized the puncture needle.
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Li W, Wang P, Le S, Xi W, Wang J, Yin L, Wang Q, Zhang Y, Wang Z. Benefits may not outweigh risks of low molecular weight heparin (LMWH) in early postoperative thromboprophylaxis following minimally invasive cardiac surgery: a propensity score-matched analysis. J Thorac Dis 2020; 11:5266-5273. [PMID: 32030244 DOI: 10.21037/jtd.2019.11.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Whether the benefits of early prophylactic anticoagulation by low molecular weight heparin (LMWH) would outweigh its possible harms in patients after minimally invasive cardiac surgery (MICS) remains contentious. The aims of this study were to define the incidence of venous thromboembolism (VTE) and to assess whether early prophylactic anticoagulation by LMWH postoperatively was indeed effective in reducing VTE without increasing risk of complications after MICS. Methods This investigation was a single-center, retrospective, propensity score-matched analysis study. A total of 473 patients underwent MICS, of whom 257 received prophylactic anticoagulation with LMWH (LMWH group) in the early postoperative period and 216 were not treated with LMWH (Control group). The main outcome measurements included the incidence of embolism events and major bleeding events, the volume of erythrocyte transfusion, the volume of drainage and the duration of drainage after MICS. In addition, the incidence of poor wound healing, the mechanical ventilation time, ICU stay time and postoperative hospitalization time were also documented. Results There were fewer embolic events (P=1.000) and a higher rate of major bleeding events (P=0.008) in the LMWH group than the Control group, and their magnitude and significance were maintained in the propensity matched analysis. In the matched cohorts, there was no significant difference in the total volume of red blood cell transfusion (P=0.552), assisted mechanical ventilation time (P=0.542), and the ICU stay time (P=0.166) between the two groups; while the volume of drainage (P<0.001) and the duration of drainage (P<0.001) in the LMWH group were significantly more than the Control group, and the incidence of poor wound healing (P=0.009) and the postoperative hospitalization time (P<0.001) were significantly increased in the LMWH group. Conclusions Early prophylactic anticoagulation with LMWH could not reduce the incidence of embolism events after MICS. Instead, it might increase postoperative major bleeding events and prolong drainage tube indwelling time and the length of hospital stay.
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Affiliation(s)
- Wei Li
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.,Department of Cardiothoracic Surgery, General Hospital of Central Theater Command, Wuhan 430012, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Shiguan Le
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.,Department of Surgery, 69220 Hospital of Chinese People's Liberation Army, Kuqa County 842000, China
| | - Wang Xi
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Jing Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Liang Yin
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Qing Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Yufeng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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Zhang TF, Fu Z, Wang Y, Shi WY, Chen GB, Fei J. Lesion positioning method of a CT-guided surgical robotic system for minimally invasive percutaneous lung. Int J Med Robot 2020; 16:e2044. [PMID: 31674135 DOI: 10.1002/rcs.2044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Robot-assisted puncture has gradually attracted more attention and practical clinical application. The lesion positioning and the needle positioning are the basis to ensure the accuracy of puncture and the key techniques in insertion operation. METHODS A lesion positioning method is established which is realized only by the robot-CT system without using external positioning system, and an omnidirectional needle positioning method is also developed and realized by using VRCM, in order to make the puncture needle always keep pointing to the lesion point. A CT-guided surgical robotic system used for minimally invasive percutaneous lung is designed and the physical prototype is manufactured, to perform in-vitro experiments, thereby to validate the effectiveness of the lesion positioning method and the feasibility of omnidirectional needle positioning method. RESULTS The accuracy of established lesion positioning method based on three non-collinear markers is within 3 mm, which is similar to that of the least squares method based on the five non-coplanar markers, but the positioning efficiency can be improved by about 40%, and the non-collinearity of markers is easier to be satisfied than non-coplanarity in practical applications. The average calculation error of the established positioning method is 0.997 mm. Moreover, the omnidirectional positioning of the puncture needle under the designed surgical robot is feasible. CONCLUSIONS The designed surgical robot has good control accuracy and it can satisfy the requirements for use. The established lesion positioning method can provide a good precision basis for robot-assisted puncture surgery. The suitable insertion point and insertion posture can be determined by the developed omnidirectional needle positioning method. This study can provide theoretical reference for further study of path planning or autonomous positioning.
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Affiliation(s)
| | - Zhuang Fu
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Wang
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Wei-Yi Shi
- Baoshan District Dachang Hospital, Shanghai, China
| | - Guang-Biao Chen
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Fei
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
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Choi W, Chang HW, Kang SH, Yoon CH, Cho YS, Youn TJ, Chae IH, Kim DJ, Kim JS, Park KH, Kim HS, Lim C, Suh JW. Comparison of Minimally Invasive Direct Coronary Artery Bypass and Percutaneous Coronary Intervention Using Second-Generation Drug-Eluting Stents for Coronary Artery Disease - Propensity Score-Matched Analysis. Circ J 2019; 83:1572-1580. [PMID: 31130585 DOI: 10.1253/circj.cj-18-1330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Some studies comparing minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) have reported MIDCAB's superiority, but they did not investigate contemporary PCI with newer generation drug-eluting stents (DES). We compared clinical outcomes after MIDCAB with previously reported outcomes after PCI with second-generation DES.Methods and Results:We retrospectively reviewed the records of patients treated with MIDCAB. Baseline characteristics and clinical outcomes after MIDCAB were compared with those for left anterior descending artery disease treated via PCI. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), a composite of cardiovascular death, non-fatal myocardial infarction, ischemic stroke, and target vessel revascularization (TVR). A propensity score-matching (PSM) analysis was conducted to adjust for between-group differences in baseline characteristics. We analyzed 77 patients treated with MIDCAB and 2,206 treated with PCI. The MIDCAB group was older and had more severe coronary disease and a higher incidence of left ventricular dysfunction. Over a 3-year follow-up, the PCI group had favorable MACCE outcomes. After PSM, there were no between-group differences in MACCE (MIDCAB, 15.6% vs. PCI, 23.4%; hazard ratio [HR], 0.80; 95% CI: 0.38-1.68, P=0.548) or TVR (MIDCAB, 2.6% vs. PCI, 5.2%; HR, 0.51; 95% CI: 0.10-3.09, P=0.509). CONCLUSIONS Clinical outcomes were similar between MIDCAB and PCI using second-generation DES over 3 years of follow-up.
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Affiliation(s)
- Wonsuk Choi
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Chang-Hwan Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Young-Seok Cho
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Tae-Jin Youn
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
| | - Dong Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital.,Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine
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Abad C, Urso S, Clavo B. New trends in cardiac surgery: Toward a less-invasive surgical procedure. J Thorac Cardiovasc Surg 2019; 157:e268-e269. [DOI: 10.1016/j.jtcvs.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/01/2018] [Indexed: 12/15/2022]
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Abusamra R, Król M, Milewski K, Kachel M, Abudaqa L, Jankowska-Sanetra J, Derbisz K, Sanetra K, Sobieszek A, Buszman PP, Wojakowski W, Buszman PE, Bochenek A, Cisowski M. Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis. Cardiol J 2019; 28:86-94. [PMID: 30701513 DOI: 10.5603/cj.a2019.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/07/2018] [Accepted: 01/08/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To perform a retrospective analysis of patients who underwent endoscopic atraumatic coronary artery off-pump bypass grafting (EACAB) in a single center over a period of 11 years. METHODS Data was acquired from the hospital registry and patient medical records. In order to determine changes in clinical profile, patients were subdivided into three groups regarding year of surgery: 1998-2002 (group 1), 2003-2005 (group 2), 2006-2009 (group 3). In-hospital analysis up to 30 days and long-term observation were conducted. RESULTS The study cohort consisted of 714 patients (581 male). Procedural success accounted for 99% of all patients. No mortality was observed up to 30 days. Complications in the early period included pleural effusion (7.6%), cardiac arrhythmias (3.6%), bleeding related revision (2.7%) and wound infection (1.6%). Mean follow-up was 6 years (2132 ± 1313 days; median: 1918.5). Nineteen (2.7%) patients died, of which 52.6% (10 patients) were due to heart related conditions. Overall frequency of major adverse cerebral and cardiovascular events (MACCE) was 10.8% (77 patients). The Kaplan-Meyer analysis defined survival rate and event-free survival in long-term observation of 96.1% and 85.3%, respectively. Ejection fraction (EF) < 50% was the only independent factor of mortality (OR: 3.35). Regarding cumulative MACCE, older age (OR: 1.72), lower EF (OR: 3.03), the history of percutaneous coronary intervention (OR: 2.13) and higher New York Heart Association class (OR: 2.63) influenced the incidence rate. CONCLUSIONS The presented short and very long-term results confirm that EACAB is an efficient alternative for patients requiring revascularization of the left anterior descending artery. The elimination of cardiopulmonary bypass significantly reduces the number of complications.
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Affiliation(s)
- Rafik Abusamra
- Al Zahra Hospital Sharjah, United Arab Emirates.,Medical University of Silesia, Katowice, Poland
| | - Marek Król
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Mateusz Kachel
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.
| | | | - Justyna Jankowska-Sanetra
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Kamil Derbisz
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Krzysztof Sanetra
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Anna Sobieszek
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Piotr P Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | | | - Paweł E Buszman
- Medical University of Silesia, Katowice, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Andrzej Bochenek
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,Medical University of Silesia, Katowice, Poland
| | - Marek Cisowski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,Medical University of Silesia, Katowice, Poland
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Reynolds AC, King N. Hybrid coronary revascularization versus conventional coronary artery bypass grafting: Systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11941. [PMID: 30113498 PMCID: PMC6112891 DOI: 10.1097/md.0000000000011941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) combining minimally invasive grafting of the left internal mammary artery to the left anterior descending artery with percutaneous coronary intervention has become a viable option for treating coronary artery disease. The aim of this meta-analysis was to compare HCR with conventional coronary artery bypass grafting (CABG) in a range of clinical outcomes and hospital costs. METHODS To identify potential studies, systematic searches were carried out in various databases. The key search terms included "hybrid revascularization" AND "coronary artery bypass grafting" OR "HCR" OR "CABG." This was followed by a meta-analysis investigating the need for blood transfusion, hospital costs, ventilation time, hospital stay, cerebrovascular accident, myocardial infarction, mortality, postoperative atrial fibrillation, renal failure, operation duration, and ICU stay. RESULTS The requirement for blood transfusion was significantly lower for HCR: odds ratio 0.38 (95% confidence intervals [CIs] 0.31-0.46, P < .00001) as was the hospital stay: mean difference (MD) -1.48 days (95% CI, -2.61 to -0.36, P = 0.01) and the ventilation time: MD -8.99 hours (95% CI, -15.85 to -2.13, P = .01). On the contrary, hospital costs were more expensive for HCR: MD $3970 (95% CI, 2570-5370, P < .00001). All other comparisons were insignificant. CONCLUSIONS In the short-term, HCR is as safe as conventional CABG and may offer certain benefits such as a lower requirement for blood transfusion and shorter hospital stays. However, HCR is more expensive than conventional CABG.
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Zubair MH, Smith JM. Updates in Minimally Invasive Cardiac Surgery for General Surgeons. Surg Clin North Am 2017; 97:889-898. [DOI: 10.1016/j.suc.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Liao Y, Long X, Zhu S, Tu J, Wen H, Xu J, Wu Y. Minimally access via left anterior mini-thoracotomy for repair of adult subarterial ventricular septal defects. J Cardiothorac Surg 2017; 12:48. [PMID: 28606107 PMCID: PMC5469133 DOI: 10.1186/s13019-017-0611-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Minimally invasive cardiac surgical techniques are increasingly applied in the treatment and management of a variety of adult ventricular septal defects (VSDs). However, repair of adult subarterial VSDs via left anterior mini-thoracotomy is rarely reported. The present study aimed to determine the feasibility and safety of the left anterior mini-thoracotomy for the repair of adult subarterial VSDs. Methods Twenty-seven adult patients underwent repair of subarterial VSDs via left anterior mini-thoracotomy. The approach includes two options for skin incision access, longitudinal and transverse skin incisions. The skin incision length was 4.1–6.1 cm (mean, 5.1 ± 0.6 cm). The closure of the VSDs was obtained through the main pulmonary artery under direct visualization. Results Successful repair of the defects was achieved in all the patients. No patients died or converted to median sternotomy. Average durations of cardiopulmonary bypass (CPB) and aortic cross-clamp were 102.5 ± 13.6 min (range, 85–127 min) and 54.6 ± 6.9 min (range, 45–66 min), respectively. No patients required blood transfusion. The average postoperative hospital stay was 5.1 ± 0.7 days (range, 4–6 days). There were no postoperative complications related to the operative procedures or peripheral cannulation. During the follow-up of 5.4–32.3 months, no patients were found to have residual shunt, wound infections, pericardial effusion, neurologic or other complications. Conclusion Our experiences demonstrate that minimally invasive cardiac surgical technique via left anterior mini-thoracotomy can be served as a novel, feasible and safe alternative for the repair of adult subarterial VSDs.
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Affiliation(s)
- YunFei Liao
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Xiang Long
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - ShuQiang Zhu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Jun Tu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Hua Wen
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - JianJun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - YongBing Wu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China.
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Kawashima T, Sato F. Anatomical visualization of neural course and distribution of anterior ascending aortic plexus. Heart Vessels 2017; 32:1262-1270. [PMID: 28516212 DOI: 10.1007/s00380-017-0993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/12/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study was to document the detailed anatomy of neural course and distribution on the anterior ascending aorta, to identify the high and low density areas of the anterior ascending aortic plexus for further understandings in cardiovascular surgery. The embalmed hearts of 42 elderly individuals were submacroscopically and microscopically examined, after excluding any that were macroscopically abnormal. With its origins in the anterior ascending aortic plexus, the right coronary plexus substantially innervated the right coronary artery, the right atrium and ventricle, and the sinus node. The intensive neural area extending from 10 mm lateral to the interatrial groove below the pericardial reflection as far as the right coronary artery opening contained almost all the right coronary plexus in 61.3% of patients, and more than 40.9% of the total nerve volume of the anterior ascending aortic plexus. Our findings suggest that the most superior and lateral area on the ascending aorta show the lowest neural density of right coronary component in the anterior ascending aortic plexus and the high density areas are invisible in right lateral field of view as seen in the right trans-axillary MICS approach.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nish, Ota-ku, Tokyo, 143-8540, Japan.
| | - Fumi Sato
- Department of Anatomy, School of Medicine, Toho University, 5-21-16 Omori-Nish, Ota-ku, Tokyo, 143-8540, Japan
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Liu Z, He W, Jia Q, Yang X, Liang S, Wang X. A comparison of extraluminal and intraluminal use of the Uniblocker in left thoracic surgery: A CONSORT-compliant article. Medicine (Baltimore) 2017; 96:e6966. [PMID: 28538393 PMCID: PMC5457873 DOI: 10.1097/md.0000000000006966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the feasibility and safety issues concerning extraluminal use of the Uniblocker for one-lung ventilation (OLV) in the left thoracic surgery. METHODS Forty patients undergoing elective left thoracic surgery were included in this study, and all patients were randomly allocated to extraluminal use of Uniblocker group (E group, n = 20) or intraluminal use of Uniblocker group (I group, n = 20). Time for intubation, time for verification of the correct position of Uniblocker, incidence of Uniblocker displacement, index of pulmonary collapse, mean arterial pressure, heart rate, peak airway pressure, oxygen saturation in two-lung ventilation, and 30 minutes after OLV, bronchial damage after OLV, sore throat, and hoarseness postoperative were recorded. RESULTS The time for positioning Uniblocker was 112.6 ± 31.2 seconds in intraluminal use group, whereas the time for positioning Uniblocker was significantly shorter in extraluminal use group (63.4 ± 15.8 seconds). The incidence of main bronchial injury, the time of intubation, the incidence of Uniblocker malposition after initial placement, the time of OLV, the degree of pulmonary collapse, mean arterial pressure, heart rate, peak airway pressure, oxygen saturation in two-lung ventilation, and 30 minutes after OLV, the incidence of sore throat and hoarseness postoperative have no statistical significance (P > .05). CONCLUSION Extraluminal use of the Uniblocker was proved to be a more rapid and more accurate method than conventional intraluminal use of the Uniblocker for OLV in left thoracic surgery.
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Affiliation(s)
- Zhuo Liu
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang
| | - WenSheng He
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - QianQian Jia
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - XiaoChun Yang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - ShuJuan Liang
- Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - XiuLi Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang
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