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Koulaouzidis G, Charisopoulou D, Bomba P, Stachura J, Gasior P, Harpula J, Zarifis J, Marlicz W, Hudziak D, Jadczyk T. Robotic-Assisted Solutions for Invasive Cardiology, Cardiac Surgery and Routine On-Ward Tasks: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:399. [PMID: 37754828 PMCID: PMC10532157 DOI: 10.3390/jcdd10090399] [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: 06/28/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive cardiac electrophysiology procedures as well as surgical operations including minimally invasive aortic and mitral valve repair, coronary artery bypass procedures, and structural heart diseases. Furthermore, machines are used as staff-assisting tools to support nurses with repetitive clinical duties i.e., food delivery. High precision and resolution allow for excellent maneuverability, enabling the performance of medical procedures in challenging anatomies that are difficult or impossible using conventional approaches. Moreover, robot-assisted techniques protect operators from occupational hazards, reducing exposure to ionizing radiation, and limiting risk of orthopedic injuries. Novel automatic systems provide advantages for patients, ensuring device stability with optimized utilization of fluoroscopy. The acceptance of robotic technology among healthcare providers as well as patients paves the way for widespread clinical application in the field of cardiovascular medicine. However, incorporation of robotic systems is associated with some disadvantages including high costs of installation and expensive disposable instrumentations, the need for large operating room space, and the necessity of dedicated training for operators due to the challenging learning curve of robotic-assisted interventional systems.
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Affiliation(s)
- George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Dafni Charisopoulou
- Pediatric Cardiology Department, Great Ormond Street Hospital, London WC1N 3JH, UK;
| | | | | | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - Jan Harpula
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - John Zarifis
- Cardiology Department, George Papanikolaou General Hospital, 570 10 Thessaloniki, Greece;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 71-455 Szczecin, Poland;
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland;
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, 602 00 Brno, Czech Republic
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Lin TH, Wang CW, Shen CH, Chang KH, Lai CH, Liu TJ, Chen KJ, Chen YW, Lee WL, Su CS. Clinical outcomes of multivessel coronary artery disease patients revascularized by robot-assisted vs conventional standard coronary artery bypass graft surgeries in real-world practice. Medicine (Baltimore) 2021; 100:e23830. [PMID: 33545949 PMCID: PMC7837900 DOI: 10.1097/md.0000000000023830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/20/2020] [Indexed: 11/18/2022] Open
Abstract
The treatment of patients with multivessel coronary artery disease (MVD) by coronary stenting (PCI) and the "gold standard" conventional coronary-artery bypass grafting (C-CABG) has been well explored in the literature. However, the clinical outcomes of robot-assisted CABG (R-CABG) vs C-CABG in MVD patients in real-world practice were unknown. We aimed to study the clinical outcomes of MVD patients who underwent R-CABG (robotic MIDCAB) and C-CABG at our institution between January 2005 and December 2013.A total of 516 MVD patients received CABG were recruited into this study. Among them, 281 patients received R-CABG and 235 patients underwent C-CABG. Patients in the R-CABG group were younger, and had fewer vessels with coronary artery disease (CAD), lower prevalence of chronic renal disease (CKD), higher left ventricular ejection fraction (LVEF), as well as lower Euro scores. The in-hospital and long-term mortalities were lower in the R-CABG group, but the incidences of target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), and stroke were not significantly different between the two groups. The long-term mortality was related to age, lower LVEF, and CKD, but not residual SYNTAX score, or completeness of revascularization. The revascularization modality (R-CABG vs C-CABG) was a borderline significantly independent predictor of long-term mortality (OR 1.76 [0.99-3.14], P = .055).Our study concluded that R-CABG, in comparison with C-CABG, for MVD carried out in younger patients involved fewer clinical complexities was associated with lower in-hospital and long-term mortalities in real-world practice. However, the long-term rates of TLR, TVR, MI, and stroke were similar. The long-term mortality was correlated with age, lower LVEF, and CKD, where R-CABG remained a borderline significant predictor after correcting for confounding factors. R-CABG could be an effective alternative to C-CABG for MVD patients with fewer clinical complexities in real-world practice.
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Affiliation(s)
- Tzu-Hsiang Lin
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Chi-Wei Wang
- Division of Cardiology, Asia University Hospital
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Department of Medicine and Surgery, National Yang Ming University School of Medicine, Taipei
| | - Keng-Hao Chang
- Department of Internal Medicine, Cheng Ching Hospital, Taichung
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital
- Institute of Clinical Medicine
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital
- Department of Medicine, National Yang Ming University School of Medicine
| | - Kuan-Ju Chen
- Cardiovascular Center, Taichung Veterans General Hospital
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital
- Department of Medicine, National Yang Ming University School of Medicine
| | - Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital
- Institute of Clinical Medicine
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Mirzai S, Hibino N, Torregrossa G, Balkhy HH. Adult Ventricular Septal Defect Repair Using a Robotic Totally Endoscopic Approach: A Case Report. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:372-375. [PMID: 32403961 DOI: 10.1177/1556984520922978] [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] [Indexed: 11/16/2022]
Abstract
The growth and advancement of minimally invasive cardiac surgery in recent years has allowed robotic and totally endoscopic procedures to become safe and effective options for the treatment of patients with various diseases of the heart. However, despite these advances, outcome data for robotic correction of congenital cardiac anomalies are scarce. This is particularly true for robotic ventricular septal defect (VSD) repair with initial experiences only recently having been published by a single group. Here, we present the case of a 29-year-old female who underwent robotic totally endoscopic VSD repair due to persistent symptoms with resolution of preoperative shunting and severe tricuspid regurgitation following surgery. This unique case adds to the limited data currently available in the literature on robotic VSD repair to show that it is a safe procedure when performed by a dedicated surgical team experienced in minimally invasive robotic cardiac surgery. We feel that, in this setting, the benefits of a robotic surgical approach can be afforded to more patients with excellent results.
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Affiliation(s)
- Saeid Mirzai
- 376598 Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Narutoshi Hibino
- 12246 Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Gianluca Torregrossa
- 12246 Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Husam H Balkhy
- 12246 Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
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Dixit S, Sharma A, Suthar J, Watti V, Sharma M. Repair of ventricular septal defect through anterolateral thoracotomy with central cannulation: our experience. Indian J Thorac Cardiovasc Surg 2020; 36:476-482. [PMID: 32421064 PMCID: PMC7223385 DOI: 10.1007/s12055-020-00929-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background At present thoracotomy with femoro-femoral bypass is an established approach for minimally invasive open heart surgeries, but thoracotomy with conventional cannulation is yet to be established. We performed 54 cases of ventricular septal defect (VSD) closure via anterolateral thoracotomy approach with central cannulation. Here we are describing our results and experience of VSD closure via anterolateral thoracotomy approach. Aim and objective The aim of our study was to evaluate early outcomes of VSD repair via anterolateral thoracotomy with central cannulation. Methods This is a retrospective, observational, descriptive type of study. Fifty four patients (31 males, 23 females) underwent VSD repair from November 2016 to November 2018 via anterolateral thoracotomy with age ranges from 3 to 22 years (mean age 10.57 + 8.88 years). Mean body weight was 22.29 + 13.44 kg (range 10 to 48 kg). The VSD was perimembranous in 47 patients, subpulmonic in 2, muscular in 2, and inlet in 3 patients. Results There was no operative or late mortality. The mean incision length was 7.16 ± 02.08 cm (range, 5 cm to 9 cm). Average duration of cardiopulmonary bypass (CPB) was 61.72 ± 14.20 min (range, 48–78 min), and aortic cross-clamp time was 38.51 ± 13.08 min (range, 26–56 min). The average postoperative intensive care unit (ICU) stay was 1.83 ± 1.32 days (range, 1–3 days), and hospital stay was 4.92 ± 1.82 days (range, 4–7 days). Conclusion Anterolateral thoracotomy with conventional central cannulation can be a safe alternative to median sternotomy with superior cosmetic results for the repair of VSDs.
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Affiliation(s)
- Sunil Dixit
- Department of Cardio-Vascular and thoracic surgery, S.M.S. Medical College and Group of Hospitals, Jaipur, India
| | - Anil Sharma
- Department of Cardio-Vascular and thoracic surgery, S.M.S. Medical College and Group of Hospitals, Jaipur, India
| | - Jaikishan Suthar
- Department of Cardio-Vascular and thoracic surgery, S.M.S. Medical College and Group of Hospitals, Jaipur, India
| | - Vikram Watti
- Department of Cardio-Vascular and thoracic surgery, S.M.S. Medical College and Group of Hospitals, Jaipur, India
| | - Mohit Sharma
- Department of Cardio-Vascular and thoracic surgery, S.M.S. Medical College and Group of Hospitals, Jaipur, India
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Su CS, Shen CH, Chang KH, Lai CH, Liu TJ, Chen KJ, Lin TH, Chen YW, Lee WL. Clinical outcomes of patients with multivessel coronary artery disease treated with robot-assisted coronary artery bypass graft surgery versus one-stage percutaneous coronary intervention using drug-eluting stents. Medicine (Baltimore) 2019; 98:e17202. [PMID: 31567970 PMCID: PMC6756629 DOI: 10.1097/md.0000000000017202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A number of studies have reported on treatment outcomes of coronary stenting (PCI) for multivessel coronary artery diseases (MVD), and compared them with the conventional coronary artery bypass grafting (CABG). However, the clinical outcomes of robot-assisted CABG (R-CABG) in comparison with PCI in MVD patients have not been investigated.We recruited retrospectively MVD patients receiving R-CABG and PCI with drug-eluting stents for all vessels in one stage between January 2005 and December 2013 at our institution with at least 3 years of outcomes were retrospectively recruited and analyzed.A total of 638 MVD patients were studied. Among them, 281 received R-CABG, and 357 received PCI. Similar complete revascularizations were achieved in both groups (R-CABG: 40.2%, PCI: 41.5%, P = .751). The residual stenosis was 4.1 ± 4.4 in the R-CABG group, and comparably 3.5 ± 3.7 in the PCI group (P = .077). Patients in the R-CABG group were younger, with more severe coronary artery disease (CAD) and had more background risk factors. The in-hospital and long-term mortalities as well as the incidence of TLR, myocardial infarction (MI), stroke were all similar between groups. But the incidence of TVR and any revascularization were lower in the R-CABG group. The long-term mortality was predicted by age, left ventricular ejection fraction, and chronic kidney disease, but not by the revascularization modality, completeness of revascularization, nor residual SYNTAX scores. The last 3 factors were not predictors of long-term TLR, TVR, MI, and stroke.The in-hospital and long-term survival rates of MVD were similar for both the R-CABG and PCI groups. But the R-CABG group had rates of TVR and any revascularization lower than PCI. Revascularization modality, completeness of revascularization, and residual SYNTAX scores were not predictors of in-hospital and long-term mortalities, MI, and stroke in real-world practice. R-CABG was associated with lower rates of TLR and TVR, and is likely a safe and effective treatment and an alternative choice of PCI for MVD patients who have low surgical risks.
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Affiliation(s)
- Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- School of Medicine, National Yang-Ming University, Taipei
| | - Keng-Hao Chang
- Department of Internal Medicine, Cheng Ching Hospital, Taichung
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Kuan-Ju Chen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzu-Hsiang Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei
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Duong DH, Pham QD. Closure of subarterial ventricular septal defect with minimally invasive surgical technique: A case report. Int J Surg Case Rep 2019; 58:142-144. [PMID: 31039512 PMCID: PMC6529587 DOI: 10.1016/j.ijscr.2019.04.025] [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: 03/15/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022] Open
Abstract
Minimally invasive cardiac surgery for closure of subarterial ventricular septal defect. The approach using left parasternal thoracotomy via third intercostal space. Excellent exposure of subarterial ventricular septal defect without special instruments.
Introduction Minimally invasive cardiac surgery has been applied for the treatment of ventricular septal defect (VSD) with various approaches. However, closure of subarterial VSD with minimally invasive technique via left parasternal thoracotomy is rarely reported. Case presentation A 22-year-old man, weighing 65 kg, with a diagnosis of subarterial VSD underwent successful repair with minimally invasive technique via left parasternal thoracotomy through third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. Myocardium was protected by warm blood cardioplegia injected directly into aortic root by a long needle and aortic clamp introduced through the thoracotomy incision. Discussion The left parasternal thoracotomy through third intercostal space (ICS) allows to expose both the subarterial VSD and ascending aorta. Myocardial protection and repair of this defect can be performed merely without requirements of video assistance or unique instruments. The patient recovered rapidly and was satisfied with the cosmetic result. The primary concern of this technique is mammary tissue which can be injured by a transverse incision in female patients. In this case, we can transform into the longitudinal incision. Conclusion This minimally invasive technique is feasible for the surgical treatment of subarterial VSD. Long-term follow-up and additional cases will be needed for validation of the safety and efficacy of this approach.
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Affiliation(s)
- Duc Hung Duong
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong, Dong Da, Hanoi, Viet Nam.
| | - Quoc Dat Pham
- Vietnam National Heart Institute, Bach Mai Hospital, 78 Giai Phong, Dong Da, Hanoi, Viet Nam.
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Hu Y, Deng J, Zhao S, Zhong Q. Left thorax approach to repair doubly committed juxta-arterial ventricular septal defect with Da Vinci robotic system. J Card Surg 2019; 34:495-498. [PMID: 30981213 DOI: 10.1111/jocs.14036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Abstract
Robotic repair of the ventricular septal defect was performed mainly for perimembranous type via right thorax approach. Minimally invasive strategies for doubly committed juxta-arterial ventricular septal defect were limited. Here, for the first time, we successfully repaired a doubly committed juxta-arterial ventricular septal defect with Da Vinci robotic system via left thorax approach. The technique could provide excellent exposure of surgical field and accurate repair, with the advantage of reducing trauma and shortening the overall length of stay.
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Affiliation(s)
- Yijie Hu
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical Center of PLA, Chongqing, China
| | - Jianying Deng
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical Center of PLA, Chongqing, China
| | - Shulin Zhao
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical Center of PLA, Chongqing, China
| | - Qianjin Zhong
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical Center of PLA, Chongqing, China
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Dang HQ, Le HT. Totally endoscopic ventricular septal defect repair using bilateral femoral arterial cannulation in an 8-year-old girl. Int J Surg Case Rep 2019; 55:4-6. [PMID: 30641324 PMCID: PMC6330555 DOI: 10.1016/j.ijscr.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/14/2018] [Indexed: 11/10/2022] Open
Abstract
The scope of totally endoscopic cardiac surgery in children is limited. Femoral cannulation has risks which increase in small children. Bilateral femoral arterial cannulation helped to avoid vessel complication in small children. Four small trocars (5–12 mm) were suitable for totally endoscopic VSD closure.
Introduction There are few reports on applying totally endoscopic surgery (TES) for repairing ventricular septal defect (VSD), especially in children. Case presentation We described an 8-year-old girl, weighing 17 kg, who was diagnosed with peri-membranous VSD and patent ductus arteriosus (PDA). The patient had undergone trans-catheter PDA closure first, and 3 weeks later, TES was performed for VSD repair through 4 small trocars (one 12 mm trocar and three 5 mm trocars) without robotic assistance. Arterial line was set up indirectly to the right femoral artery (FA) through a graft with an additional line to the left side for reducing arterial pressure. Discussion FA cannulation in small children induce some risks, such as: FA trauma, critical lower limb ischaemia, and iliac or femoral arterial stenosis. Our new method of FA cannulation was safe with 13 months of follow-up. The major concerns in this case were repairing VSD through small trocars in a small child. Conclusion Bilateral FA cannulation and the way to set up small trocars may facilitate totally endoscopic VSD repair in small children. However, the safety and efficacy of these approaches needs to be validated by larger studies preferably randomised controlled trials.
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Affiliation(s)
- Huy Q Dang
- Minimally Invasive Cardiac Surgery Unit, Cardiovascular Center, Hanoi Heart Hospital, Hanoi, Viet Nam.
| | - Huong T Le
- Institute of Preventive Medicine and Public Health, Hanoi Medical University (HMU), Hanoi, Viet Nam
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Totally Endoscopic Surgical Repair of Partial Atrioventricular Septal Defect in Children: Two Cases. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:368-371. [PMID: 30394955 DOI: 10.1097/imi.0000000000000551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There have been few reports on the application of totally endoscopic surgery for repairing partial atrioventricular septal defect. In this report, we present two children who were successfully repaired partial atrioventricular septal defect by using totally endoscopic surgery without robotic assistance.
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Su CS, Chen YW, Shen CH, Liu TJ, Chang Y, Lee WL. Clinical outcomes of left main coronary artery disease patients undergoing three different revascularization approaches. Medicine (Baltimore) 2018; 97:e9778. [PMID: 29443740 PMCID: PMC5839844 DOI: 10.1097/md.0000000000009778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Significant unprotected left main (LM) coronary artery disease is frequently associated with severe multivessel disease and increased mortality and morbidity compared with non-LM coronary artery disease. This study compared the clinical outcomes of patients with LM disease who received percutaneous coronary intervention (PCI) with stenting, conventional coronary-artery bypass grafting (C-CABG), and robot-assisted CABG (R-CABG).This retrospective study analyzed 472 consecutive LM disease patients who underwent three different revascularization approaches at a tertiary medical center between January 2005 and November 2013.Of the 472 LM disease patients, 139 received R-CABG, 147 received C-CABG, and 186 received PCI. The need for target vessel revascularization (TVR) was highest in the PCI group. The R-CABG group had significantly lower rates of in-hospital and follow-up all-cause deaths compared with the other 2 groups (1.4% vs. 3.4% and 9.7%, P = .0058; 13.7% vs. 29.3% and 29.6%, P = .0023, respectively). Patients in the R-CABG group had significantly lower rates of intra-aortic balloon pump assistance, and shorter duration of ICU and total hospital stay compared to patients in the C-CABG group. However, revascularization modality, SYNTAX scores, and residual SYNTAX scores were not independent predictors of in-hospital or long-term mortality.In this cohort of LM disease patients treated at a tertiary medical center, PCI is a reasonable choice in patients with less lesion complexity but who are older and have comorbidities. R-CABG is feasible in stable LM disease patients with high SYNTAX scores, and is an effective alternative to C-CABG in LM disease patients with few risk factors. However, revascularization modality per se was not a determinant for long-term mortality in our real-world practice.
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Affiliation(s)
- Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Division of Cardiology, Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Department of Surgery
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Yen Chang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
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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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Liu H, Wang Z, Xia J, Hu R, Wu Z, Hu X, Ren W. Evaluation of Different Minimally Invasive Techniques in Surgical Treatment for Ventricular Septal Defect. Heart Lung Circ 2017; 27:365-370. [PMID: 29153964 DOI: 10.1016/j.hlc.2017.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/08/2016] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Minimally invasive cardiac surgery is becoming a safe and cosmetic alternative to standard median sternotomy (SMS). This retrospective study reviews our results and experience with the lower mini-sternotomy (LMS) technique and the right lateral thoracotomy (RLT) technique for ventricular septal defect (VSD) closure compared with SMS. METHODS Between January 2013 and Dec 2015, 198 patients underwent repair VSD through lower mini-sternotomy (LMS Group, n=66), right lateral thoracotomy (RLT Group, n=59), standard median sternotomy (SMS Group, n=73). Cardiopulmonary bypass was achieved directly in the three different approaches. RESULTS Procedures were performed successfully in all patients among the three groups and no in-hospital mortality occurred. No patient was reverted to standard median sternotomy in the LMS Group and RLT Group. The CPB time was 37.73±11.46 mins in the LMS Group, 41.3±13.97 mins in the RLT Group and 36.99±10.84 mins in the SMS Group (p=0.078); the cross-clamp times were 23.85±9.78 mins in the LMS Group, 22.54±9.08 mins in the RLT Group and 19.23±6.92 mins in the SMS Group (p=0.009). The total incision length of the procedure in the SMS Group (7.45±1.54cm) was longer than the other groups (LMS Group, 5.58±0.8cm and RLT Group, 5.96±1.48cm) and the difference was significant (p<0.001). CONCLUSIONS Both the LMS and RLT approach can be performed with favourable cosmetic and acceptable clinical results for closing VSD. They are the promising alternatives to standard median sternotomy and merit further study.
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Affiliation(s)
- Huagang Liu
- Department of Cardiovascular Surgery, Wuhan University, Renmin Hospital, Wuhan, Hubei 430060, P.R. China
| | - Zhiwei Wang
- Department of Cardiovascular Surgery, Wuhan University, Renmin Hospital, Wuhan, Hubei 430060, P.R. China.
| | - Jun Xia
- Department of Cardiovascular Surgery, Wuhan University, Renmin Hospital, Wuhan, Hubei 430060, P.R. China
| | - Rui Hu
- Department of Cardiovascular Surgery, Wuhan University, Renmin Hospital, Wuhan, Hubei 430060, P.R. China
| | - Zhiyong Wu
- Department of Cardiovascular Surgery, Wuhan University, Renmin Hospital, Wuhan, Hubei 430060, P.R. China
| | - Xiaoping Hu
- Department of Cardiovascular Surgery, Wuhan University, Renmin Hospital, Wuhan, Hubei 430060, P.R. China
| | - Wei Ren
- Department of Cardiovascular Surgery, Wuhan University, Renmin Hospital, Wuhan, Hubei 430060, P.R. China
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Poffo R, Toschi AP, Pope RB, Montanhesi PK, Santos RS, Teruya A, Hatanaka DM, Rusca GF, Fischer CH, Vieira MC, Makdisse MR. Robotic cardiac surgery in Brazil. Ann Cardiothorac Surg 2017; 6:17-26. [PMID: 28203537 DOI: 10.21037/acs.2017.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci® robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil. METHODS From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy. RESULTS The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term. CONCLUSIONS Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra- and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.
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Affiliation(s)
- Robinson Poffo
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alisson P Toschi
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Renato B Pope
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Paola K Montanhesi
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ricardo S Santos
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alexandre Teruya
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Dina M Hatanaka
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Gabriel F Rusca
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Claudio H Fischer
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcelo C Vieira
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcia R Makdisse
- Centro de Cirurgia Cardíaca Minimamente Invasiva e Robótica, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Totally Endoscopic Robotic Correction of Cor Triatriatum Sinister Coexisting with Atrial Septal Defect. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:451-452. [PMID: 27922989 DOI: 10.1097/imi.0000000000000326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cor triatriatum sinister (CTS) is a rare congenital cardiac anomaly and is mainly corrected through conventional surgery through sternotomy. We described our successful novel surgical technique of totally robotic correction of CTS in one case of CTS with concomitant repair of atrial septal defect using da Vinci SI Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA USA) with excellent surgical outcome. We conclude that robotic correction of CTS is a feasible and safe alternative to conventional surgical technique.
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Gao C, Yang M, Xiao C, Zhang H, Wang G. Totally Endoscopic Robotic Correction of Cor Triatriatum Sinister Coexisting with Atrial Septal Defect. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Changqing Gao
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, Beijing, China
| | - Ming Yang
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, Beijing, China
| | - Cangsong Xiao
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, Beijing, China
| | - Huajun Zhang
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, Beijing, China
| | - Gang Wang
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, Beijing, China
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Onan B, Aydin U, Turkvatan A, Bakir I. Robot-Assisted Repair of Right Partial Anomalous Pulmonary Venous Return. J Card Surg 2016; 31:394-7. [DOI: 10.1111/jocs.12753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Burak Onan
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
| | - Unal Aydin
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
| | - Aysel Turkvatan
- Department of Radiology; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
| | - Ihsan Bakir
- Department of Cardiovascular Surgery; Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital; Istanbul Turkey
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Gao C, Yang M, Xiao C, Zhang H. Totally robotic repair of atrioventricular septal defect in the adult. J Cardiothorac Surg 2015; 10:156. [PMID: 26545987 PMCID: PMC4636820 DOI: 10.1186/s13019-015-0358-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 10/28/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Atrioventricular septal defect (AVSD) accounts for up to 3 % of congenital cardiac defects, which is routinely repaired via median sternotomy. Minimally invasive approach such as endoscopic or robotic assisted repair for AVSD has not been reported in the literature. With the experience with robotic mitral valve surgery and congenital defect repair, we initiated robotic AVSD repair in adults. CASE PRESENTATION In this report, we presented three cases of successful repair of partial and intermediate AVSD by using da Vinci SI surgical system (Intuitive Surgical, Inc., Sunnyvale, CA). CONCLUSIONS Totally robotic AVSD repair via right atriotomy could be safely performed in adults and it may provide superior cosmesis with the comparable surgical outcome of the repair via sternotomy.
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Affiliation(s)
- Changqing Gao
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Ming Yang
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Cangsong Xiao
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Huajun Zhang
- Department of Cardiovascular Surgery, Institute of Cardiac Surgery, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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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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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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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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Poffo R, Toschi AP, Pope RB, Celullare AL, Benício A, Fischer CH, Vieira MLC, Teruya A, Hatanaka DM, Rusca GF, Makdisse M. Robotic surgery in cardiology: a safe and effective procedure. EINSTEIN-SAO PAULO 2014; 11:296-302. [PMID: 24136755 PMCID: PMC4878587 DOI: 10.1590/s1679-45082013000300007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/28/2013] [Indexed: 11/21/2022] Open
Abstract
Objective: To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery. Methods: From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy. Results: The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days. Conclusion: Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies.
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