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Liu Y, Ge S, Li X, Lu C, Zhang C, Liu Z. Comparative analysis of robotically-assisted versus conventional sternotomy approach in left atrial myxoma resection: A single-center retrospective observational study. Asian J Surg 2024:S1015-9584(24)00374-9. [PMID: 38443251 DOI: 10.1016/j.asjsur.2024.02.112] [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: 09/06/2023] [Revised: 12/10/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Minimally invasive surgery has emerged as a favorable alternative to conventional surgery for various cardiac conditions. This study aimed to compare the perioperative outcomes and follow-up results of the robotic approach versus the sternotomy approach for left atrial myxoma (LAM) resection. METHOD We retrospectively analyzed the perioperative outcomes and follow-up results of 94 patients who underwent left atrial myxoma resection using either the sternotomy approach (n = 64) or the robotic approach (n = 30) at our center between January 2017 and April 2023. Multiple linear regressions were employed to examine the actual impact of the surgical approach on perioperative outcomes while controlling for potential confounding factors. RESULTS There were no in-hospital deaths or follow-up deaths in the robotic group. Univariate analyses revealed that robotic LAM resection had a longer cardiopulmonary bypass (CPB) time (99.93 ± 22.30 vs. 76.28 ± 24.92, P < 0.001), longer aortic clamping time (57.80 ± 20.27 vs. 47.89 ± 18.10, P = 0.019), reduced postoperative drainage (P < 0.001), shorter mechanical ventilation time (P = 0.005), shorter postoperative bed-stay time (P < 0.001), shorter postoperative hospitalization time (P = 0.040), and higher hospital costs (P = 0.001) compared to the sternotomy group. After adjusting for baseline characteristics in a multiple regression model, a longer CPB time (B = 28.328; CI, 18.609-38.047; P < 0.001), longer aortic clamping time (B = 11.856; CI, 4.069-19.644; P = 0.003), reduced postoperative drainage (B = -200.224; CI, -254.962- -145.486; P < 0.001), shorter mechanical ventilation time (B = -3.429; CI, -6.562- -0.295; P = 0.032), shorter postoperative bed-stay time (B = -2.230; CI, -3.267- -1.193; P < 0.001), shorter postoperative hospitalization time (B = -1.998; CI, -3.747- -0.250; P = 0.026), and higher hospital costs (B = 2096.866, P = 0.002) were found in the robotic group. Furthermore, the robotic group exhibited a faster return to exercise compared to the sternotomy group (Log-Rank χ2 = 34.527, P < 0.001). CONCLUSION Both the robotic and sternotomy approaches are viable and safe options for LAM resection. However, despite the higher costs, longer CPB time, and longer aortic clamping time associated with robotic LAM resection, this technique was correlated with reduced postoperative drainage and faster postoperative recovery compared to the sternotomy technique.
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Affiliation(s)
- Yanyi Liu
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Shenglin Ge
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Xin Li
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chenghao Lu
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chengxin Zhang
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
| | - Zhuang Liu
- Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Golzarian H, Turnow M, Elston S, Kannan P, Chakraborty S, Widmer MB, Mughal S, Kohan S, Nguyen M, Sabik JF, Patel SM. A mysterious case of chest pain, dyspnea, and palpitations in a healthy young female: Citalopram or robotic minithoracotomy? JTCVS Tech 2023; 20:123-126. [PMID: 37555039 PMCID: PMC10405183 DOI: 10.1016/j.xjtc.2023.05.005] [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: 02/16/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Hafez Golzarian
- Internal Medicine Residency Program, Mercy Health–St Rita's Medical Center, Lima, Ohio
| | - Morgan Turnow
- Internal Medicine Residency Program, Mercy Health–St Rita's Medical Center, Lima, Ohio
| | - Sidney Elston
- Internal Medicine Residency Program, Mercy Health–St Rita's Medical Center, Lima, Ohio
| | - Pavithra Kannan
- Internal Medicine Residency Program, Mercy Health–St Rita's Medical Center, Lima, Ohio
| | - Shudipan Chakraborty
- Internal Medicine Residency Program, Mercy Health–St Vincent's Medical Center, Toledo, Ohio
| | - Michael B. Widmer
- Internal Medicine Residency Program, Mercy Health–St Rita's Medical Center, Lima, Ohio
| | - Sulayman Mughal
- Internal Medicine Residency Program, Mercy Health–St Rita's Medical Center, Lima, Ohio
| | - Salar Kohan
- Internal Medicine Residency Program, Mercy Health–St Rita's Medical Center, Lima, Ohio
| | - Michael Nguyen
- Internal Medicine Residency Program, Mercy Health–St Rita's Medical Center, Lima, Ohio
| | - Joseph F. Sabik
- Department of Cardiothoracic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sandeep M. Patel
- Structural Heart and Intervention Center, Mercy Health–St Rita's Medical Center, Lima, Ohio
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Makkad B, Heinke TL, Sheriffdeen R, Khatib D, Brodt JL, Meng ML, Grant MC, Kachulis B, Popescu WM, Wu CL, Bollen BA. Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2. Anesth Analg 2023; 137:26-47. [PMID: 37326862 DOI: 10.1213/ane.0000000000006506] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Pain after cardiac surgery is of moderate to severe intensity, which increases postoperative distress and health care costs, and affects functional recovery. Opioids have been central agents in treating pain after cardiac surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure. This Practice Advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of cardiac surgical patients. This Practice Advisory provides recommendations for providers caring for patients undergoing cardiac surgery. This entails developing customized pain management strategies for patients, including preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various cardiac surgical procedures. The literature related to this field is emerging, and future studies will provide additional guidance on ways to improve clinically meaningful patient outcomes.
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Affiliation(s)
- Benu Makkad
- From the Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Timothy Lee Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Raiyah Sheriffdeen
- Department of Anesthesiology, Medstar Washington Hospital Center, Washington, DC
| | - Diana Khatib
- Department of Anesthesiology, Weil Cornell Medical College, New York, New York
| | - Jessica Louise Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bessie Kachulis
- Department of Anesthesiology, Columbia University, New York, New York
| | - Wanda Maria Popescu
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Christopher L Wu
- Department of Anesthesiology, Hospital of Special Surgery, Weill Cornell Medical College, New York, New York
| | - Bruce Allen Bollen
- Missoula Anesthesiology, Missoula, Montana
- The International Heart Institute of Montana, Missoula, Montana
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4
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Liu Y, Liu Z, Li X, Jiang Y, Lu C, Zhang C, Ge S. A comparison of total thoracoscopic versus robotic approach for cardiac myxoma resection: a single-center retrospective study. J Robot Surg 2023:10.1007/s11701-023-01531-z. [PMID: 36648634 PMCID: PMC10374789 DOI: 10.1007/s11701-023-01531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
Advances in instrumentation and technique have facilitated minimally invasive surgeries for cardiac myxoma treatment. This study aims to compare the clinical outcomes between the thoracoscopic and robotic approaches for myxoma resection. Intraoperative data and postoperative data of 46 patients who underwent either thoracoscopic (n = 15) or robotic (n = 31) cardiac myxoma resection in our center between July 2013 and September 2022 were retrospectively compared. There was no in-hospital death in either group. Meanwhile, the operative time and cardiopulmonary bypass time were significantly shorter in the robotic group than in thoracoscopic group (P = 0.015 and P = 0.035, respectively). Furthermore, shorter ICU stays (P = 0.006), shorter postoperative mechanical ventilation time (P = 0.035) and less thoracic drainage (P = 0.040) were observed in the robotic group. However, the operating room costs and total hospital costs were both significantly lower in thoracoscopic group (P = 0.004 and P = 0.007, respectively). There was no significant difference between two groups regarding the incidence of postoperative complications (P > 0.05). Lastly, a faster return to exercise was noted in robotic group than in thoracoscopic group (Log-Rank χ2 = 4.094, P = 0.043). Both approaches can be safe and feasible for myxoma resection. However, regardless of higher expenses, the robotic myxoma resection approach provides shorter operation time, less postoperative thoracic drainage, and faster recovery than total thoracoscopic technique.
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Affiliation(s)
- Yanyi Liu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Zhuang Liu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Xin Li
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Yiyao Jiang
- Department of Cardiac Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, Anhui, China
| | - Chenghao Lu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Chengxin Zhang
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China.
| | - Shenglin Ge
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China.
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5
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Islam AKMM. Cardiac myxomas: A narrative review. World J Cardiol 2022; 14:206-219. [PMID: 35582466 PMCID: PMC9048271 DOI: 10.4330/wjc.v14.i4.206] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/28/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.
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Affiliation(s)
- A K M Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka 1207, Bangladesh
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6
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Zhao H, Gao C, Yang M, Wang Y, Kang W, Wang R, Zhang H. Surgical effect and long-term clinical outcomes of robotic mitral valve replacement: 10-year follow-up study. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 62:162-168. [PMID: 33302613 DOI: 10.23736/s0021-9509.20.11508-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To assess the safety and effectiveness, clinical experience with totally robotic mitral valve replacement (TE-MVR) for treating valvular heart disease was summarized and analyzed, and patients' recovery conditions were followed-up. METHODS The clinical data of 47 patients who received TE-MVR in our hospital between October 2008 and December 2015 were retrospectively analyzed. Among the patients, there are 26 men and 21 women. The mean age was 47.53±10.80 years. We followed up the transesophageal echocardiography (TTE) data of post-discharge patients and analyzed the operation results to determine the surgical effects of TE-MVR. The surgeries were mainly performed with the da Vinci Si robotic surgical system. RESULTS Thirty-five mechanical valves and twelve bioprosthetic valves were implanted. The cardiopulmonary bypass and aortic cross-clamping times were 122.02±25.45 min and 85.68±20.70 min, respectively. There was no operative mortality. The perioperative complication could only be found in one case, which was pleural effusion. All the TTE results were satisfying before discharge. No paravalvular leakage or prosthetic valve dysfunction was detected. All 47 patients were discharged successfully. During the long-term follow-up (28-110 months), 42 patients were followed-up (89.4%). Most of their heart function was NYHA class I and II. The postoperative TTE showed that the left atrial diameter and left ventricle diameter were decreased (P<0.01). CONCLUSIONS TE-MVR is reliable and effective, and the postoperative follow-up results revealed good heart function. Patients will obtain benefits from TE-MVR, such as small trauma and rapid recovery. Thus, it is a good minimally-invasive surgery of choice.
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Affiliation(s)
- Haizhi Zhao
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China.,Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Changqing Gao
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China.,Institute of Cardiac Surgery, PLA General Hospital, Beijing, China
| | - Ming Yang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Yao Wang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Wenbin Kang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Rong Wang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China -
| | - Huajun Zhang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China.,Institute of Cardiac Surgery, PLA General Hospital, Beijing, China
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7
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Moscarelli M, Rahouma M, Nasso G, di Bari N, Speziale G, Bartolomucci F, Pepe M, Fattouch K, Lau C, Gaudino M. Minimally invasive approaches to primary cardiac tumors: A systematic review and meta-analysis. J Card Surg 2020; 36:483-492. [PMID: 33259109 DOI: 10.1111/jocs.15224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification. METHODS A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intraoperative and postoperative outcomes; tumor size was also considered. RESULTS There were no significant between-group differences in terms of late mortality (incidence rate ratio [IRR]: MI vs. MS, 0.98 [95% confidence interval [CI]: 0.25-3.82], p = .98). Few relapses (IRR: 1.13; CI: 0.26-4.88; p = .87) and redo surgery (IRR: 1.92; 95% CI: 0.39-9.53; p = .42) were observed in both groups; MI approach resulted in prolonged operation time but that did not influence the clinical outcomes. Tumor size did not significantly differ between groups. CONCLUSION Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Mohamed Rahouma
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | | | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | | | - Martino Pepe
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Christopher Lau
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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8
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Zhao H, Zhang H, Yang M, Xiao C, Wang Y, Gao C, Wang R. [Comparison of quality of life and long-term outcomes following mitral valve replacement through robotically assisted versus median sternotomy approach]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1557-1563. [PMID: 33243731 DOI: 10.12122/j.issn.1673-4254.2020.11.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the mid- and long-term outcomes of patients receiving mitral valve replacement through robotically assisted and conventional median sternotomy approach. METHODS The data of 47 patients who underwent da Vinci robotic mitral valve replacement in our hospital between January, 2007 and December, 2015 were collected retrospectively (robotic group). From a total of 286 patients undergoing mitral valve replacement through the median thoracotomy approach between March, 2002 and June, 2014, 47 patients were selected as the median sternotomy group for matching with the robotic group at a 1:1 ratio. The perioperative data and follow-up data of the patients were collected, and the quality of life (QOL) of the patients at 30 days and 6 months was evaluated using the Quality of Life Short Form Survey (SF-12). The time of returning to work postoperatively and the patients' satisfaction with the surgical incision were compared between the two groups. RESULTS All the patients in both groups completed mitral valve replacement successfully, and no death occurred during the operation. In the robotic group, only one patient experienced postoperative complication (pleural effusion); in median sternotomy group, one patient received a secondary thoracotomy for management of bleeding resulting from excessive postoperative drainage, and one patient died of septic shock after the operation. The volume of postoperative drainage, postoperative monitoring time, ventilation time, and postoperative hospital stay were significantly smaller or shorter in the robotic group than in the thoracotomy group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups. Assessment of the patients at 30 days after the operation showed a better quality of life in the robotic group, but the difference between the two groups tended to diminish at 6 months. The patients in the robotic group reported significantly better satisfaction with the incision than those in the thoracotomy group (P < 0.001). At 6 months after the operation, the patients in the robotic group showed significantly faster recovery of work and daily activities than those in the thoracotomy group. CONCLUSIONS Robotically assisted mitral valve replacement is safe and reliable. Compared with the median sternotomy approach, the robotic approach is less invasive and promotes faster postoperative recovery of the patients, who have better satisfaction with the quality of life and wound recovery.
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Affiliation(s)
- Haizhi Zhao
- Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China.,Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne 50939, Germany
| | - Huajun Zhang
- Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China
| | - Ming Yang
- Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China
| | - Cangsong Xiao
- Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China
| | - Yao Wang
- Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China
| | - Changqing Gao
- Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China
| | - Rong Wang
- Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China
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9
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A comparison of robotically-assisted endoscopic versus sternotomy approach for myxoma excision: A single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:450-459. [PMID: 32953207 DOI: 10.5606/tgkdc.dergisi.2020.19278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/05/2020] [Indexed: 11/21/2022]
Abstract
Background In this study, we present our single-center experience in robotically-assisted endoscopic surgery versus conventional median sternotomy approach in patients undergoing cardiac myxoma excision. Methods Between January 2011 and September 2019, a total of 46 patients (24 males, 22 females; mean age 54.1±12.5 years; range, 25 to 79 years) who had a confirmed diagnosis of isolated cardiac myxoma were included in the study. The patients were divided into two groups as those undergoing robotic-assisted surgery (n=16) and those undergoing conventional median sternotomy (n=30). Clinical characteristics, operative, and postoperative outcomes were compared. Robotic approach to right or left-sided tumors and postoperative pain scores were also analyzed. Results There was no mortality or major complication. No conversion to sternotomy was needed in robotic procedures. The mean cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the median sternotomy group (p=0.001 for both). The mean ventilation time and the length of hospital stay were significantly shorter in robotic surgery than sternotomy group (p=0.043 and p=0.048, respectively). The mean amount of postoperative blood loss and transfusion rate were significantly lower in robotic surgery patients (p=0.001 and p=0.022, respectively). The mean postoperative pain scores were significantly lower in patients undergoing robotic surgery (p=0.022). Conclusion Robotic-assisted endoscopic surgery can be performed safely and effectively for cardiac myxoma excision with shorter hospital stay, less pain, and less amount of blood product use, as well as more favorable cosmetic results compared to conventional median sternotomy.
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10
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11
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Akhmerov A, Chung JS, Emerson D, Chikwe J, Trento A. Successful robotic resection of a primary cardiac synovial sarcoma. JTCVS Tech 2020; 2:104-106. [PMID: 34317769 PMCID: PMC8298838 DOI: 10.1016/j.xjtc.2020.02.005] [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: 12/29/2019] [Accepted: 02/02/2020] [Indexed: 10/28/2022] Open
Affiliation(s)
- Akbarshakh Akhmerov
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Joshua S Chung
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, Calif
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Alfredo Trento
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
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12
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The Future of Open Heart Surgery in the Era of Robotic and Minimal Surgical Interventions. Heart Lung Circ 2020; 29:49-61. [DOI: 10.1016/j.hlc.2019.05.170] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/17/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
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13
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Mori M, Angraal S, Chaudhry SI, Suter LG, Geirsson A, Wallach JD, Krumholz HM. Characterizing Patient-Centered Postoperative Recovery After Adult Cardiac Surgery: A Systematic Review. J Am Heart Assoc 2019; 8:e013546. [PMID: 31617435 PMCID: PMC6898802 DOI: 10.1161/jaha.119.013546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Improving postoperative recovery is important, with a national focus on postacute care, but the volume and quality of evidence in this area are not well characterized. We conducted a systematic review to characterize studies on postoperative recovery after adult cardiac surgery using patient‐reported outcome measures. Methods and Results From MEDLINE and Web of Science, studies were included if they prospectively assessed postoperative recovery on adult patients undergoing cardiac surgery using patient‐reported outcome measures. Six recovery domains were defined by prior literature: nociceptive symptoms, mental health, physical function, activities of daily living, sleep, and cognitive function. Of the 3432 studies, 105 articles met the inclusion criteria. The studies were small (median sample size, 119), and mostly conducted in single‐center settings (n=81; 77%). Study participants were predominantly men (71%) and white (88%). Coronary artery bypass graft was included in 93% (n=98). Studies commonly selected for elective cases (n=56; 53%) and patients with less comorbidity (n=67; 64%). Median follow‐up duration was 91 (interquartile range, 42–182) days. Studies most commonly assessed 1 domain (n=42; 40%). The studies also varied in the instruments used and differed in their reporting approach. Studies commonly excluded patients who died during the follow‐up period (n=48; 46%), and 45% (n=47) did not specify how those patients were analyzed. Conclusions Studies of postoperative patient‐reported outcome measures are low in volume, most often single site without external validation, varied in their approach to missing data, and narrow in the domains and diversity of patients. The evidence base for postoperative patient‐reported outcome measures needs to be strengthened.
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Affiliation(s)
- Makoto Mori
- Section of Cardiac Surgery Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Suveen Angraal
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Sarwat I Chaudhry
- Section of General Internal Medicine Department of Medicine Yale School of Medicine New Haven CT
| | - Lisa G Suter
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Rheumatology Department of Medicine Yale School of Medicine New Haven CT.,Section of Rheumatology Department of Medicine VA Medical Center West Haven CT
| | - Arnar Geirsson
- Section of Cardiac Surgery Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Joshua D Wallach
- Department of Environmental Health Sciences Yale School of Public Health New Haven CT.,Collaboration for Research Integrity and Transparency (CRIT) Yale School of Medicine New Haven CT
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT
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14
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Nazir T, Ahmed S, Ahmed IM. Left atrial myxoma: an unusual cause of postpartum tachycardia and shortness of breath. BMJ Case Rep 2019; 12:12/9/e231283. [PMID: 31527217 DOI: 10.1136/bcr-2019-231283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary cardiac tumours are exceedingly rare in clinical practice and a myxoma is certainly not the first suspected diagnosis on a list of differentials in a patient presenting with breathlessness and tachycardia. Naturally, a structured work-up to rule out much more common conditions will take place. Nonetheless, an index of clinical suspicion is required especially when a clear-cut diagnosis is not forthcoming. We describe a case of a postpartum woman who presented with shortness of breath and palpitations, and was eventually diagnosed with a left atrial tumour. She underwent a successful surgical excision of the mass which was found to be a myxoma on histological examination. We review and present an up-to-date literature review on epidemiology, pathophysiology, clinical features, diagnosis and treatment options for cardiac myxomas.
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Affiliation(s)
- Tahir Nazir
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Saad Ahmed
- Department of Cardiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Irfan Munir Ahmed
- Department of Cardiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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15
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Early experience with robotic mitral valve repair with intra-aortic occlusion. J Thorac Cardiovasc Surg 2018; 155:1463-1471. [DOI: 10.1016/j.jtcvs.2017.10.076] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 09/25/2017] [Accepted: 10/09/2017] [Indexed: 11/21/2022]
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16
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李 双, 高 长. [Robotic surgery versus conventional open chest surgery for heart tumor: a propensity score matching analysis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1296-1300. [PMID: 29070457 PMCID: PMC6743956 DOI: 10.3969/j.issn.1673-4254.2017.10.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare conventional open chest surgery and robotic surgery for their efficacy, short?term outcomes and patient selection in the treatment of heart tumors. Method The clinical data were collected from 225 patients (a total of 228 operations) who underwent cardiac neoplasm resection in our hospital between January, 1993 and April, 2016. A propensity score matching (PSM) was established according to the vital baseline data of the patients receiving conventional open chest surgery (n=125) and robotic surgery (n=60) after screening. The patients were matched for propensity into 60 pairs, and the efficacy, short?term outcomes and patient selection were compared between the two groups. RESULTS Before PSM, the patients in conventional surgery group had significantly greater tumor size (P<0.001) and a higher proportion of patients with New York Heart Association functional class III and IV (P<0.001). The patients' baseline data were nearly balanced (P=0.982) between the two groups after matching. No significant differences were found between the two groups in cardiopulmonary bypass time (P=0.256), crossclamp time (P=0.862), in?hospital mortality (P=1.000), arrhythmia (P=1.000), delayed mechanical ventilation (>24 h; P=0.209), thoracic complications (P=0.611) or systemic embolism (P=1.000). The survival rates were 100% in both groups in the 6?month follow?up after the operation, and no significant difference was found between the two groups in the incidence of major adverse cardiac and cerebrovascular events within 6 months (P=0.438). CONCLUSION Robotic heart tumor resection has a favorable efficacy with a good short?term prognosis, and can serve as an alternative for treatment of solitary lesions in low?risk patients receiving operations for the first time.
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Affiliation(s)
- 双磊 李
- />中国人民解放军总医院心血管外科, 北京 100853Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China
| | - 长青 高
- />中国人民解放军总医院心血管外科, 北京 100853Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China
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17
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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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18
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Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach. Case Rep Cardiol 2017; 2017:8510160. [PMID: 28567309 PMCID: PMC5439244 DOI: 10.1155/2017/8510160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/06/2017] [Indexed: 12/02/2022] Open
Abstract
This case report concerns a young woman who, during her pregnancy, suffered severe mitral regurgitation. It was discovered at the same time that she had a left atrial myxoma. During the early postpartum period she successfully underwent an anterior minithoracotomy to remove the left atrial myxoma in conjunction with repair of the mitral valve. The thoracotomy approach in this specific patient was chosen as it would give a better chance of successful mother-child bonding because the patient would be able to avoid the precautions which would have been necessary following a sternotomy, especially the limitation of her ability to hold her child during the first 4–6 weeks postoperatively.
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19
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Medical robots in cardiac surgery - application and perspectives. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:79-83. [PMID: 28515758 PMCID: PMC5404137 DOI: 10.5114/kitp.2017.66939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/12/2017] [Indexed: 11/17/2022]
Abstract
Medical robots offer new standards and opportunities for treatment. This paper presents a review of the literature and market information on the current situation and future perspectives for the applications of robots in cardiac surgery. Currently in the United States, only 10% of thoracic surgical procedures are conducted using robots, while globally this value remains below 1%. Cardiac and thoracic surgeons use robotic surgical systems increasingly often. The goal is to perform more than one hundred thousand minimally invasive robotic surgical procedures every year. A surgical robot can be used by surgical teams on a rotational basis. The market of surgical robots used for cardiovascular and lung surgery was worth 72.2 million dollars in 2014 and is anticipated to reach 2.2 billion dollars by 2021. The analysis shows that Poland should have more than 30 surgical robots. Moreover, Polish medical teams are ready for the introduction of several robots into the field of cardiac surgery. We hope that this market will accommodate the Polish Robin Heart robots as well.
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20
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Li S, Gao C. Surgical Experience of Primary Cardiac Tumor: Single-Institution 23-Year Report. Med Sci Monit 2017; 23:2111-2117. [PMID: 28469127 PMCID: PMC5426384 DOI: 10.12659/msm.903324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Primary cardiac tumors are rare but have favorable surgical prognosis. Previous studies have been small series studies with limited surgical approaches. To date, few studies have examined the clinical features associated with different surgical procedures. Material/Methods In a search of the cardiovascular surgery database of our institution, we retrospectively identified 225 patients who had cardiac tumor resection from January 1993 to May 2016. The patients’ clinical characteristics and operation information were reviewed, and the operation parameters, postoperative complications, and short-term prognosis among robotic, mini-thoracotomy, and conventional procedures in our center were compared. Results A total of 228 operations were performed, including 156 traditional open surgeries (68.4%), 60 robotically assisted neoplasm resections (26.3%), and 12 mini-thoracotomy procedures (5.3%). Among 232 lesions, myxoma (94.8%) was the most common neoplasm, and the remainders were fibroma (1.3%) and lipoma (0.9%). Operative complications occurred in 36 patients (15.8%). Arrhythmia (8.8%) was the first common complication, and delayed mechanical ventilation (4.8%) ranked second. The overall risk of recurrence of myxoma was 2.7%. The cardiopulmonary bypass (CPB) time in the mini-thoracotomy group was longer than in the robotic group (p=0.034) and the conventional group (p=0.002). There were no significant differences in cross clamp time (p=0.266) or complications (p=0.835) among the three groups. The in-hospital survival rate was 100% in all patients. There were no significant differences in main adverse events among the three groups at six-month follow-up (p=0.285). Conclusions Prognosis for cardiac neoplasm surgical resection is favorable for primary cardiac tumors. The minimally invasive surgery of cardiac tumor resection can be an alternative to conventional operations in selected patients.
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Affiliation(s)
- Shuanglei Li
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China (mainland)
| | - Changqing Gao
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China (mainland)
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21
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Demirkilic U, Kadan M, Doganci S, Bolcal C, Yildirim V, Alhan C. Unrecognized indication for robot-assisted cardiac surgery: Patients with acute psychotic disorders. MINIM INVASIV THER 2015; 25:117-9. [DOI: 10.3109/13645706.2015.1119701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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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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23
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Lee R. The life in your years. J Thorac Cardiovasc Surg 2015; 150:157-8. [PMID: 25791953 DOI: 10.1016/j.jtcvs.2015.02.021] [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: 02/06/2015] [Accepted: 02/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Richard Lee
- Center for Comprehensive Cardiovascular Care, St Louis University, St Louis, Mo.
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