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Piperata A, Busuttil O, Jansens JL, Modine T, Pernot M, Labrousse L. A Single Center Initial Experience with Robotic-Assisted Minimally Invasive Coronary Artery Bypass Surgery (RA-MIDCAB). J Pers Med 2022; 12:1895. [PMID: 36422071 PMCID: PMC9694867 DOI: 10.3390/jpm12111895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Minimally invasive procedures have demonstrated their effectiveness in reducing the recovery times while ensuring optimal results and minimizing complications. Regarding the coronary artery surgical revascularization field, the evolution of techniques and technology is permitting new surgical strategies that are increasingly precise and suitable for each patient. We present an initial single center experience with a case series of patients successfully treated with combined robotic harvesting of the left internal mammary artery (LIMA) and minimally invasive direct coronary artery bypass graft (MIDCAB) for the anastomosis. METHODS We retrospectively reviewed the records of patients who underwent minimally invasive coronary artery revascularization with the use of two combined techniques at our Institution between January 2021 and October 2022. RESULTS A total of 17 patients underwent coronary artery bypass grafting with the described approach. The median cardiopulmonary bypass (CPB) and cross-clamp times were 83 min (76-115) and 38 min (32-58), respectively. The median intensive care unit (ICU) and hospital stay were 2 days (1-4) and 8 days (6-11), respectively. The procedure's success was achieved in 100% of patients. The 30-day mortality was 0%. CONCLUSIONS Considering all the limitations related to the small sample, the presented results of a hybrid approach for minimally invasive coronary artery bypass grafting (CABG) appears to be encouraging and acceptable. The main advantage of this approach is related to the reduction of postoperative pain and pulmonary complications.
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Affiliation(s)
- Antonio Piperata
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Jean-Luc Jansens
- Department of Cardiac Surgery, Erasme Hospital of Brussels, Belgium free University of Brussels (ULB), Hôpital Erasme, 1070 Brussels, Belgium
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Louis Labrousse
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Balkhy HH. Robotic totally endoscopic coronary artery bypass grafting: It's now or never! JTCVS Tech 2021; 10:153-157. [PMID: 34977718 PMCID: PMC8690331 DOI: 10.1016/j.xjtc.2021.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Husam H. Balkhy
- Address for reprints: Husam H. Balkhy, MD, FACS, FACC, Section of Cardiac Surgery, University of Chicago, 5841 S Maryland Ave, E-500, Chicago, IL 60637.
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Cheng N, Zhang H, Yang M, Liu G, Guo Y, Kang W, Gao C, Wang R. Eleven-year outcomes of U-clips in totally robotic coronary artery bypass grafting versus standard hand-sewn running suture in robotic-assisted coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 33:27-33. [PMID: 33729469 DOI: 10.1093/icvts/ivab053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical outcomes of patients undergoing off-pump robotic coronary artery bypass grafting (CABG) with either interrupted nitinol U-Clips in totally endoscopic coronary artery bypass (TECAB) or standard running suture anastomosis in robotically assisted direct coronary artery bypass (RADCAB) over a decade. METHODS From January 2007 to December 2017, 280 patients underwent robotic off-pump CABG using the da Vinci S/Si Surgical System in our centre. TECAB with interrupted nitinol U-Clips anastomosis was performed in the left internal mammary artery (LIMA) to LAD grafting in 126 patients and RADCAB (n = 154) of the LIMA to LAD was completed with standard running suture. After discharge, patients were contacted through telephone interview and were invited to attend the outpatient clinic every 6 months or 1 year. The graft patency was assessed by coronary angiography or computed tomography angiography. RESULTS All cases were completed without conversion to median sternotomy or cardiopulmonary bypass. A total of 275 single internal mammary artery (IMA) grafts (271 LIMAs, 4 right internal mammary arteries) and 5 bilateral IMA grafts were used as single graft or composite grafts. All the patients were discharged without in-hospital mortality or adverse outcomes. The average follow-up was 89.7 ± 30.4 months (range, 14-143 months). The cumulative survival rates (P = 0.53), the cumulative IMA patency rates (P = 0.83), and the rates of freedom from major adverse cerebrovascular and cardiovascular events (P = 0.41) between TECAB and RADCAB all showed no significant difference in the follow-up. CONCLUSIONS Robotic off-pump CABG using IMA grafts is safe and can provide reliable long-term outcomes. Compared with the standard hand-sewn running suture technique in RADCAB, interrupted suture with the nitinol U-Clips in TECAB showed similar long-term clinical results and graft patency in LIMA to LAD bypass grafting.
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Affiliation(s)
- Nan Cheng
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Huajun Zhang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Ming Yang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Guopeng Liu
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Yi Guo
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Wenbin Kang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Changqing Gao
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Rong Wang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
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Kitahara H, Nisivaco S, Balkhy HH. Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:117-123. [DOI: 10.1177/1556984519836896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective With advances in robotic instrumentation and technology, both robotically assisted minimally invasive direct coronary artery bypass (RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been widely used over the past 20 years. Graft patency is the most important outcome in coronary bypass surgery and is associated with long-term prognosis. In this article we reviewed all experts’ studies in the field of robotic assisted coronary artery bypass and investigated graft patency in patients who underwent RMIDCAB or TECAB. Methods We performed a literature search in PubMed from 1999 to 2018 using the terms “Robotic” and “Coronary bypass” and/or “Minimally invasive” and/or “Totally endoscopic.” Of the articles found, studies investigating graft patency were specifically selected. Results In 33 articles, a total of 4,000 patients underwent robotic assisted coronary artery bypass surgery either by a RMIDCAB (2,396) or by a TECAB (1,604) approach. The graft patency was assessed by invasive angiography or computed tomographic angiography in all studies. The mean graft patency at early (<1 month), midterm (<5 years), and long-term (>5 years) follow-up was 97.7%, 96.1%, and 93.2% in RMIDCAB and 98.8%, 95.8%, and 93.6% in TECAB, respectively. Conclusions The graft patency of robotic assisted coronary artery bypass was equivalent to reported outcomes of the conventional approach. These results should encourage the adoption of robotic approaches in coronary bypass surgery.
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Alamdar A, Hanife S, Farahmand F, Behzadipour S, Mirbagheri A. A minimally invasive robotic surgery approach to perform totally endoscopic coronary artery bypass on beating hearts. Med Hypotheses 2019; 124:76-83. [PMID: 30798923 DOI: 10.1016/j.mehy.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/11/2018] [Accepted: 02/01/2019] [Indexed: 01/01/2023]
Abstract
The currently available robotic systems rely on rigid heart stabilizers to perform totally endoscopic coronary artery bypass (TECAB) surgery on beating hearts. Although such stabilizers facilitate the anastomosis procedure by immobilizing the heart and holding the surgery site steady, they can cause damage to the heart tissue and rupture of the capillary vessels, due to applying relatively large pressures on the epicardium. In this paper, we propose an advanced robotic approach to perform TECAB on a beating heart with minimal invasiveness. The idea comes from the fact that the main pulsations of the heart occur as excursions in normal direction, i.e., perpendicular to the heart surface. We devise a 1-DOF flexible heart stabilizer which eliminates the lateral movements of the heart, and a 1-DOF compensator mechanism which follows the heart trajectory in the normal direction, thus canceling the relative motion between the surgical tool and the heart surface. In fact, we bring a compromise between two radical approaches of operating on a completely immobilized beating heart with no heart motion compensation, and operating on a freely beating heart with full compensation of heart motion, considering the invasiveness of the first and the technical challenges of the second approach. We propose operating on a partially stabilized beating heart with unidirectional compensation of the heart motion; the flexible stabilizer would exert much less holding force to the heart tissue and the robotic system with unidirectional compensator would be technically feasible. In the proposed approach, a motion sensor mounted on the stabilizer measures the heart excursion data and sends it into a control unit. A predictive controller uses this data to generate an automated trajectory. The slave robots follow this trajectory, which is superimposed on the surgeon's tele-operation commands received from a master console. Finally, the tool-activation units in the slave robots actuate the articulated laparoscopic tools to perform the anastomosis procedure. The evaluation of the hypothesis showed that our solution for the robotic TECAB on beating heart is both practical and cost effective. We showed in an in-vivo study that the flexible stabilizer can effectively restrict the heart lateral movements, while allowing for its normal excursion. We found readily available linear motors which could afford the high forces, speeds and accelerations required for following the heart trajectory. Finally, we showed that the tool-activation unit is capable of providing the maneuverability and workspace required for the most challenging task of CABG procedure, i.e., anastomosis suturing.
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Affiliation(s)
- Alireza Alamdar
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Shahrzad Hanife
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran; Research Center for Biomedical Technologies and Robotics (RCBTR), Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Behzadipour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Alireza Mirbagheri
- Department of Medical Physics & Biomedical Engineering, School of Medicine, Iran; Research Center for Biomedical Technologies and Robotics (RCBTR), Tehran University of Medical Sciences, Tehran, Iran.
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Stastny L, Kofler M, Dumfarth J, Basaran A, Wiedemann D, Schachner T, Feuchtner G, Bonatti J, Bonaros N. Long-Term Clinical and Computed Tomography Angiographic Follow-up After Totally Endoscopic Coronary Artery Bypass Grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:5-10. [PMID: 29465628 DOI: 10.1097/imi.0000000000000461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Totally endoscopic coronary artery bypass grafting was shown to be feasible and safe, with excellent clinical and angiographic mid-term results. Data on long-term outcome are lacking. Therefore, we aimed to investigate the long-term rate of major adverse cardiac and cerebrovascular events and left internal mammary artery patency rate in patients undergoing arrested heart totally endoscopic coronary artery bypass grafting. METHODS From 2001 to 2012, a total of 208 arrested heart-totally endoscopic coronary artery bypass grafting patients were prospectively included. Mean ± SD age was 58.8 ± 9.4 years, and mean ± SD Society of Thoracic Surgeons score was 0.5 ± 0.5%. Major adverse cardiac and cerebrovascular events were defined as a composite of death, myocardial infarction, stroke, re-percutaneous coronary intervention, re-coronary artery bypass graft, and target vessel revascularization. Left internal mammary artery patency was assessed using cardiac computed tomography and depicted according to the established Fitzgibbon classification. Mean ± SD follow-up was 6.9 ± 2.3 years. RESULTS At 1, 5, and 10 years, survival rate was 100%, 98.3%, and 95.8%, respectively. The freedom from clinical events at 1, 5, and 10 years were major adverse cardiac and cerebrovascular events (93.5%, 85.9%, and 83.0%), myocardial infarction (99.0%, 97.4%, and 95.9%), target vessel revascularization (96.0%, 94.3%, and 91.7%), re-percutaneous coronary intervention (94.5%, 91.6%, and 84.2%), and re-coronary artery bypass graft (100%, 99.5%, and 99.5%), respectively. Left internal mammary artery patency rate at 1, 5, and 10 years was 100%, 94.9%, and 88.1%, respectively. CONCLUSIONS Arrested heart-totally endoscopic coronary artery bypass grafting shows excellent clinical long-term results with a left internal mammary artery patency rate comparable with conventional coronary artery bypass graft at 10 years after surgery.
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Zakkar M, Angelini GD. Totally endoscopic coronary artery bypass grafting, the new frontier. Int J Cardiol 2018; 261:47-48. [PMID: 29657056 DOI: 10.1016/j.ijcard.2018.02.052] [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: 01/10/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
Affiliation(s)
- M Zakkar
- Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, BS2 8HW Bristol, UK
| | - G D Angelini
- Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, BS2 8HW Bristol, UK.
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Totally endoscopic coronary artery bypass surgery: A meta-analysis of the current evidence. Int J Cardiol 2018; 261:42-46. [DOI: 10.1016/j.ijcard.2017.12.071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022]
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Su P, Gu S, Liu Y, Zhang X, Yan J, An X, Gao J, Xin Y, Zhou J. Off-Pump Coronary Artery Bypass Grafting with Mini-Sternotomy in the Treatment of Triple-Vessel Coronary Artery Disease. Int Heart J 2018; 59:474-481. [PMID: 29681566 DOI: 10.1536/ihj.17-067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We have developed off-pump coronary artery bypass approach with lower distal mini-sternotomy (TM-OPCAB) for multivessel coronary revascularization. The aim of this retrospective study is to provide evidence for the feasibility and safety of this technique in the treatment of triple-vessel diseases.Two hundred eighty-eight patients with triple-vessel coronary artery disease who underwent TM-OPCAB or standard off-pump coronary artery bypass surgery (S-OPCAB) were included in this study after propensity-score matching. We retrospectively reviewed the clinical data of all patients and compared their demographic data, intra- and perioperative details, as well as short-term and long-term outcomes.TM-OPCAB resulted in significantly shorter periods of time on ventilation (P = 0.0222), shorter postoperative in-hospital stays (P < 0.0001), and lower blood transfusion rates (P = 0.0013) than S-OPCAB. Transit-time flow measurement showed there was no significant difference in postoperative graft patency between both groups. Within the 30-day post-surgical period, no death or occurrence of stroke was observed in patients undergoing TM-OPCAB or S-OPCAB. After an average of 35 months of follow-up, Kaplan-Meier survival analysis indicated that overall survival and the percentage of patients freed from major adverse cardiac and cerebrovascular events were similar between both groups. Additionally, the rate of repeat revascularization was slightly lower in the TM-OPCAB group (1.4%) than in the S-OPCAB group (2.2%), although there was no statistical difference noted.Our findings suggest that TM-OPCAB is technically feasible and safe for use in revascularization procedures in patients with triple-vessel diseases.
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Affiliation(s)
- Pixiong Su
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
| | - Song Gu
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
| | - Yan Liu
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
| | - Xitao Zhang
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
| | - Jun Yan
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
| | - Xiangguang An
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
| | - Jie Gao
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
| | - Yue Xin
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
| | - Jian Zhou
- Department of Cardiac Surgery, Heart Center, Chaoyang Hospital, Capital Medical University
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Abstract
Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific to robotic-assisted procedures.
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12
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Hua K, Zhao Y, Dong R, Liu T. Minimally Invasive Cardiac Surgery in China: Multi-Center Experience. Med Sci Monit 2018; 24:421-426. [PMID: 29353871 PMCID: PMC5788050 DOI: 10.12659/msm.905408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To the best of our knowledge, there is no nationwide data available on the development of minimally invasive cardiac surgery (MICS) in China. The purpose of this study was to report the results of MICS in 6 experienced centers in China. MATERIAL AND METHODS From September 2014 to July 2016, 1241 patients with cardiac conditions who underwent MICS procedures were randomly enrolled in 6 centers in China, and those patients were randomly selected for inclusion in this study. The MICS procedures were defined as any cardiac surgery performed through a less invasive incision, rather than a complete median sternotomy, mainly including mini-incision surgery (400, 32.2%), video-assisted approach (265, 21.3%), completely thoracoscopic approach without robotic assistance (504, 40.6%), and robotic procedure (55, 4.4%). RESULTS The 5 most common in-hospital complications were respiratory failure (28, 2.3%), reoperation for all reasons (19, 1.5%), renal failure (11, 0.9%), heart failure (9, 0.7%), and stroke (6, 0.5%). The multivariate logistic regression analysis results showed that cardiopulmonary bypass (CPB) time (P=0.033), aortic cross-clamp time (P=0.003), cannulation approach (P=0.010), and left ventricular ejection fraction (LVEF) (P=0.003) at baseline were all significant risk factors of any in-hospital complication of MICS procedures. CONCLUSIONS From our experience, minimally invasive cardiac approaches are safe and reproducible, with acceptable CPB and aortic cross-clamp time duration and low mortality.
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Affiliation(s)
- Kun Hua
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yang Zhao
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Taoshuai Liu
- Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
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13
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Stastny L, Kofler M, Dumfarth J, Basaran A, Wiedemann D, Schachner T, Feuchtner G, Bonatti J, Bonaros N. Long-Term Clinical and Computed Tomography Angiographic Follow-Up after Totally Endoscopic Coronary Artery Bypass Grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lukas Stastny
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Kofler
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Alim Basaran
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Kepler University Linz, Linz, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Bonatti
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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14
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Kuo CC, Hsing CH, Chen CI, Lee CH, Cheng BC. Robotic totally endoscopic coronary artery bypass for isolated ostial stenosis of the left coronary artery. J Thorac Dis 2017; 9:E1060-E1063. [PMID: 29312766 DOI: 10.21037/jtd.2017.10.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Isolated ostial stenosis (IOS) is a rare disease that encroaches on aorto-coronary junction of uncertain etiology. All distal coronary vessels present normally. IOS occurs predominantly in premenopausal young women with few risk factors for atherosclerotic disease. Here, we report a 40-year-old woman who had experienced crescendo angina for 4 months. Surgical revascularization was achieved by robotic totally endoscopic coronary artery bypass (TECAB) with left internal thoracic artery (LITA) graft. She resumed her daily tasks without difficulties 1 week after the operation. Postoperative computed tomographic angiography disclosed good opacification of the LITA graft and distal runoff. Robotic TECAB is a potentially feasible alternative for IOS patients, particularly in premenopausal young woman, with obvious benefits of cosmetic appearance and speedy recovery.
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Affiliation(s)
- Chia-Cheng Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medical Education, Taipei Veteran General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Anesthesiology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-I Chen
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Chen-Hui Lee
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Bor-Chih Cheng
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Technology, Tainan, Taiwan
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15
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Mansouri S, Farahmand F, Vossoughi G, Ghavidel AA, Rezayat M. Feasibility of infrared tracking of beating heart motion for robotic assisted beating heart surgery. Int J Med Robot 2017; 14. [DOI: 10.1002/rcs.1869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Saeed Mansouri
- Department of Mechanical Engineering; Sharif University of Technology; Tehran Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering; Sharif University of Technology; Tehran Iran
- RCBTR; Tehran University of Medical Sciences; Tehran Iran
| | - Gholamreza Vossoughi
- Department of Mechanical Engineering; Sharif University of Technology; Tehran Iran
| | - Alireza Alizadeh Ghavidel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center; Iran University of Medical Sciences; Tehran Iran
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16
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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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17
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Yang M, Wu Y, Wang G, Xiao C, Zhang H, Gao C. Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency. Ann Thorac Surg 2015; 100:1367-73. [DOI: 10.1016/j.athoracsur.2015.04.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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18
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Abstract
As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.
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Affiliation(s)
- Wendy K Bernstein
- Department of Anesthesiology, University of Maryland School of Medicine, USA
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19
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Yang M, Yao M, Wang G, Xiao C, Wu Y, Zhang H, Gao C. Comparison of postoperative quality of life for patients who undergo atrial myxoma excision with robotically assisted versus conventional surgery. J Thorac Cardiovasc Surg 2015; 150:152-7. [PMID: 25769777 DOI: 10.1016/j.jtcvs.2015.01.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/14/2015] [Accepted: 01/29/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Robotically assisted cardiac surgery is an alternative to conventional, open-chest surgery. Although studies have been done on the clinical effect, morbidity, and mortality of robotically assisted atrial myxoma excision, few have addressed surgical outcomes, such as pain, quality of life (QOL), and length of sick leave from work. In this study, our aim was to evaluate these clinical variables among patients after they undergo robotically assisted atrial myxoma excision surgery. METHODS Between January 2007 and January 2013, a total of 93 patients underwent either conventional sternotomy or robotically assisted atrial myxoma excision in our unit. The 36-item Medical Outcomes Study Short Form Survey was used to assess the clinical outcomes in these patients postoperatively, at day 30 and 6 months. RESULTS The QOL scores for 7 of 8 variables in the robotically assisted group were significantly higher than those in the conventional group at postoperative day 30 (P < .05). The degree of pain and its influence on work or life was lower in the robotically assisted group (P < .05), and these patients returned to work after 0.9 ± 0.1 months, whereas those in the conventional group needed a sick leave of 3.3 ± 0.4 months. CONCLUSIONS The level of restoration of normal QOL within 30 days after atrial myxoma surgery is excellent with the robotically assisted approach, which may enable early return to employment and satisfactory recovery.
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Affiliation(s)
- Ming Yang
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Minghui Yao
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Gang Wang
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Cangsong Xiao
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Yang Wu
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Huajun Zhang
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Changqing Gao
- Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
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20
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Cheng N, Gao C, Yang M, Wu Y, Wang G, Xiao C. Analysis of the learning curve for beating heart, totally endoscopic, coronary artery bypass grafting. J Thorac Cardiovasc Surg 2014; 148:1832-6. [DOI: 10.1016/j.jtcvs.2014.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/21/2014] [Accepted: 02/04/2014] [Indexed: 11/30/2022]
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21
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Xiao C, Gao C, Yang M, Wang G, Wu Y, Wang J, Wang R, Yao M. Totally robotic atrial septal defect closure: 7-year single-institution experience and follow-up. Interact Cardiovasc Thorac Surg 2014; 19:933-7. [DOI: 10.1093/icvts/ivu263] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Ikeda C, Watanabe G, Ishikawa N, Ohtake H, Tomita S. Harvesting bilateral internal thoracic arteries using a novel subxiphoid approach versus the conventional lateral thoracic approach—results of an experimental study. J Thorac Cardiovasc Surg 2014; 148:461-7. [DOI: 10.1016/j.jtcvs.2013.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/13/2013] [Accepted: 09/13/2013] [Indexed: 11/16/2022]
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23
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Chiu KM, Chen RJC. Videoscope-assisted cardiac surgery. J Thorac Dis 2014; 6:22-30. [PMID: 24455172 DOI: 10.3978/j.issn.2072-1439.2014.01.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 01/06/2014] [Indexed: 11/14/2022]
Abstract
Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspid valve repair, combined Maze procedure, atrial septal defect repair, ventricular septal defect repair, etc. Hands-on reminders and updated references are provided for reader's further understanding of the topic.
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Affiliation(s)
- Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan ; ; Department of Nursing, Oriental Institute of Technology, Taipei, Taiwan
| | - Robert Jeen-Chen Chen
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan ; ; Department of Cardiovascular Surgery, Mennonite Christian Hospital, Hualien, Taiwan
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24
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Moscarelli M, Harling L, Ashrafian H, Athanasiou T, Casula R. Challenges facing totally endoscopic robotic coronary artery bypass grafting. Int J Med Robot 2014; 11:18-29. [DOI: 10.1002/rcs.1598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 04/25/2014] [Accepted: 05/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | - Leanne Harling
- Department of Surgery and Cancer; Imperial College London; UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer; Imperial College London; UK
| | | | - Roberto Casula
- Department of Surgery and Cancer; Imperial College London; UK
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25
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26
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Fujita T, Hata H, Shimahara Y, Sato S, Kobayashi J. Initial experience with internal mammary artery harvesting with the da Vinci Surgical System for minimally invasive direct coronary artery bypass. Surg Today 2014; 44:2281-6. [PMID: 24419972 DOI: 10.1007/s00595-013-0830-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/10/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the feasibility of off-pump minimally invasive direct coronary artery bypass (MIDCAB) in combination with robotic harvesting of the left internal mammary artery (LIMA). METHODS Since 2004, 33 patients [average age, 64 years; 27 males (82%)] have undergone MIDCAB with robotic LIMA harvesting performed through the fourth or fifth intercostal space with guidance by enhanced computed tomography (CT). RESULTS No deaths or major adverse cardiac events occurred. Robotic LIMA harvesting was completed in 30 cases (91%), while three cases (9%) required conversion to a median sternotomy due to bleeding. The risk of LIMA injury significantly increased with age (p = 0.0012). For the 30 successful cases, the average harvest time was 68 min, and the average intraoperative blood loss was 306 ml, with only three patients (9%) requiring a transfusion. The graft flow was measurable in all cases (average, 34 ml/minute). All grafts were shown to be patent in postoperative evaluations, although CT revealed that the LIMA in one patient was anastomosed to an untargeted artery. CONCLUSIONS Off-pump MIDCAB in combination with robotic harvesting of the LIMA is a reasonable and less invasive procedure than the standard procedures. Potential problems include difficulty controlling bleeding from the graft, especially in elderly patients, and proper identification of the target artery.
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Affiliation(s)
- Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan,
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27
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Deshpande SP, Fitzpatrick M, Grigore AM. Pro: Robotic surgery is the preferred technique for coronary artery bypass graft (CABG) surgery. J Cardiothorac Vasc Anesth 2013; 27:802-5. [PMID: 23849526 DOI: 10.1053/j.jvca.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Seema P Deshpande
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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28
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Seco M, Edelman JJB, Yan TD, Wilson MK, Bannon PG, Vallely MP. Systematic review of robotic-assisted, totally endoscopic coronary artery bypass grafting. Ann Cardiothorac Surg 2013; 2:408-18. [PMID: 23977616 DOI: 10.3978/j.issn.2225-319x.2013.07.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 07/25/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Advancements in surgical robotic technology over the last two decades have enabled coronary artery bypass grafting to be performed totally endoscopically, and have the potential to significantly change clinical practice in the future. METHODS A systematic review of studies reporting clinical outcomes of total endoscopic coronary artery bypass grafting (TECABG) was performed. RESULTS 14 appraised studies included 880 beating heart TECABGs, 360 arrested heart TECABGs, 633 one-vessel operations and 357 two-vessel operations. Patients were generally low-risk. There was a significant learning curve. The weighted means for short-term beating heart and arrested heart TECABG results respectively were: intraoperative exclusion rate of 5.7% and 1.9%, intraoperative conversion rate of 5.6% and 15.0%, all-cause mortality of 1.2% and 0.4%, stroke of 0.7% and 0.8%, myocardial infarction of 0.8% and 1.8%, new onset atrial fibrillation of 10.7% and 5.1% and post-operative reintervention rate of 2.6% and 2.3%. The overall rate of short term postoperative graft patency for beating heart and arrested heart TECABG was 98.3% and 96.4% respectively. CONCLUSIONS Appropriate patient selection was important in minimizing the risk of intraoperative and postoperative complications. Short-term outcomes of both beating and arrested heart TECABG were acceptable, but results so far have been heterogeneous. There were fewer studies reporting intermediate to long-term outcomes, but results were encouraging, and further investigation and development of the procedure is warranted.
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Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; ; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
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29
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Deshpande SP, Lehr E, Odonkor P, Bonatti JO, Kalangie M, Zimrin DA, Grigore AM. Anesthetic Management of Robotically Assisted Totally Endoscopic Coronary Artery Bypass Surgery (TECAB). J Cardiothorac Vasc Anesth 2013; 27:586-99. [DOI: 10.1053/j.jvca.2013.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 11/11/2022]
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30
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Bonaros N, Schachner T, Lehr E, Kofler M, Wiedemann D, Hong P, Wehman B, Zimrin D, Vesely MK, Friedrich G, Bonatti J. Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: predictors of success and safety. Ann Thorac Surg 2013; 95:803-12. [PMID: 23312792 DOI: 10.1016/j.athoracsur.2012.09.071] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 08/13/2012] [Accepted: 09/28/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Robotic technology has enabled totally endoscopic coronary artery bypass (TECAB) grafting. Little information is available on factors associated with successful and safe performance of TECAB. We report a 10-year multicenter experience with 500 cases, elucidating on predictors of success and safety in TECAB procedures. METHODS Between 2001 and 2011, 500 patients (364 [73%] men; 136 [27%] women; median age [minimum-maximum] 60 years [31-90 years], median EuroSCORE 2 [0-13]), underwent TECAB. Single, double, triple, and quadruple TECAB was performed in 334, 150, 15, and 1 patient, respectively. Univariate analysis and binary regression models were used to identify predictors of success and safety. Success was defined as freedom from any adverse event and conversion procedure, safety was defined as freedom from major adverse cardiac and cerebral events, major vascular injury, and long-term ventilation. RESULTS Success and safety rates were 80% (400 cases) and 95% (474 cases), respectively. Intraoperative conversions to larger thoracic incisions were required in 49 (10%) patients. The median operative time was 305 minutes (112-1,050 minutes), and the mean lengths of stay in the intensive unit (ICU) and in hospital were 23 hours (11-1,048 hours) and 6 days (2-4 days), respectively. Independent predictors of success were single-vessel TECAB (p = 0.004), arrested-heart (AH)-TECAB (p = 0.027), non-learning curve case (p = 0.049), and transthoracic assistance (p = 0.035). The only independent predictor of safety was EuroSCORE (p = 0.002). CONCLUSIONS Single-vessel and multivessel TECAB procedures can be safely performed with good reproducible results. Predictors of success include procedure simplicity and non-learning curve cases, whereas predictors of safety are mainly associated with patient selection.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, University of Maryland, Baltimore, Maryland; Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
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31
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Totally endoscopic robotic ventricular septal defect repair in the adult. J Thorac Cardiovasc Surg 2012; 144:1404-7. [DOI: 10.1016/j.jtcvs.2012.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 12/23/2011] [Accepted: 01/04/2012] [Indexed: 11/23/2022]
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32
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Acharya MN, Ashrafian H, Athanasiou T, Casula R. Is totally endoscopic coronary artery bypass safe, feasible and effective? Interact Cardiovasc Thorac Surg 2012; 15:1040-6. [PMID: 22976997 DOI: 10.1093/icvts/ivs395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether totally endoscopic coronary artery bypass (TECAB) is safe, effective and feasible. A total of 171 papers were found, of which eight represented the best evidence. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The da Vinci robotic system was utilized in seven retrospective studies and one multicentre prospective trial, comprising 724 patients undergoing TECAB. Patient-related outcomes, including the incidence of major adverse cardiac events, graft patency and survival, were investigated. From the studies evaluated, TECAB appears to be safe operation with low complication rates and excellent early- and mid-term graft patencies. The incidence of internal thoracic artery injury was documented in four studies and ranged from 0 to 10%. Re-exploration for bleeding was necessary in 1-15% of patients. Conversion to open techniques was performed in 0-24% of cases. There was no in-hospital mortality in the majority of studies, but this reached 2.1% in a large series of 228 patients. Target-vessel reintervention rates varied between 0 and 12.1% according to the institutional experience. Pre- and post-discharge graft patencies were excellent at 93-100 and 92-100%, respectively. Intraoperative variables, such as time taken for internal thoracic artery harvest, anastomosis, cross-clamp, cardiopulmonary bypass (CPB) and the overall operation were as follows: internal thoracic artery harvest time (range 5-187 min), anastomosis time (range 6-82 min), cross-clamp time (range 30-223 min), CPB time (range 41-268 min) and operative time (range 84-600 min). TECAB is a technically demanding and time-consuming procedure associated with a significant learning curve. Proctoring and structured training programmes are currently supported by European and international societies to encourage wider uptake of the procedure. In conclusion, TECAB represents a feasible alternative to conventional coronary artery bypass in selected patients. It is associated with low morbidity and excellent mid-term graft patency. Larger, prospective and multicentre trials are required to assess the long-term and patient-reported outcomes of TECAB.
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Affiliation(s)
- Metesh Nalin Acharya
- Department of Cardiothoracic Surgery, Imperial College London, Hammersmith Hospital Campus, London, UK
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Robotically assisted mitral valve replacement. J Thorac Cardiovasc Surg 2012; 143:S64-7. [PMID: 22306218 DOI: 10.1016/j.jtcvs.2012.01.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 12/03/2011] [Accepted: 01/16/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In the present study, we determined the safety and efficacy of robotic mitral valve replacement using robotic technology. METHODS From January 2007 through March 2011, more than 400 patients underwent various types of robotic cardiac surgery in our department. Of these, 22 consecutive patients underwent robotically assisted mitral valve replacement. Of the 22 patients with isolated rheumatic mitral valve stenosis (9 men and 13 women), the mean age was 44.7 ± 19.8 years (range, 32-65). Preoperatively, all patients underwent a complete workup, including coronary angiography and transthoracic echocardiography. Of the 22 patients, 15 had concomitant atrial fibrillation. The surgical approach was through 4 right-side chest ports with femoral perfusion. Aortic occlusion was performed with a Chitwood crossclamp, and antegrade cardioplegia was administered directly by way of the anterior chest. Using 3 port incisions in the right side of the chest and a 2.5- to 3.0-cm working port, all the procedures were completed with the da Vinci S robot. RESULTS All patients underwent successful robotic surgery. Of the 22 patients, 16 received a mechanical valve and 6 a tissue valve. The mean cardiopulmonary bypass time and aortic crossclamp time was 137.1 ± 21.9 minutes (range, 105-168) and 99.3 ± 17.9 minutes (range, 80-133), respectively. No operative deaths, stroke, or other complications occurred, and no incisional conversions were required. After surgery, all the patients were followed up echocardiographically. CONCLUSIONS Robotically assisted mitral valve replacement can be performed safely in patients with isolated mitral valve stenosis, and surgical results are excellent.
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