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Lio A, Russo M, Sangiorgi B, Nicolò F, Chirichilli I, Irace F, Ranocchi F, Musumeci F. Robotic Mitral Valve Repair: Impact of Experience on Results and Complex Mitral Disease Treatment. J Clin Med 2024; 13:3744. [PMID: 38999310 PMCID: PMC11242621 DOI: 10.3390/jcm13133744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Robotically assisted mitral valve (MV) surgery is the least invasive surgical approach to the MV. The aim of the present study is to report our experience with robotically assisted MV repair, trying to define how experience could impact on postoperative results. Methods: This is a retrospective study on 144 patients who underwent robotic MV repair from November 2011 to March 2023. Patients were divided in two groups: Group 1, including 39 patients (November 2011-January 2013) operated using the Da Vinci Si system, and Group 2, including 105 patients operated (February 2020-March 2023) using the new Da Vinci Xi system. Results: Mean age was 58 ± 10 years. Increased use of external aortic clamp was observed in Group 2. A significant reduction of surgical times was observed: cardiopulmonary bypass time was 155 ± 44 min in Group 1 and 121 ± 36 min in Group 2 (p = 0.002), whereas cross-clamp time was 112 ± 25 min in Group 1 and 68 ± 39 min in Group 2 (p < 0.001). In-hospital mortality was 0.7%, and 10-year survival was 96 ± 2%. Freedom from reoperation was 100%. A higher percentage of complex and most complex MV repairs were performed in Group 2 (36% in Group 1 vs. 52% in Group 2, p = 0.001). Conclusions: Robotic-assisted MV repair is associated with excellent results. Experience is a key element to overcome the limitations of this technology. Finally, the robotic platform could improve results in difficult MV repair.
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Affiliation(s)
- Antonio Lio
- Department of Cardiac Surgery and Transplantation, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy; (M.R.); (B.S.); (F.N.); (I.C.); (F.I.); (F.R.); (F.M.)
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2
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Loulmet DF, Grossi EA. Two decades of experience with robotic mitral valve repair: What have we learned? JTCVS Tech 2024; 24:76-81. [PMID: 38835581 PMCID: PMC11145349 DOI: 10.1016/j.xjtc.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Didier F. Loulmet
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Eugene A. Grossi
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
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3
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Poffo R, Toma HE, Fudaba Curcio SA, Toschi AP, Pope RB, Echenique L. Native mitral valve endocarditis: Robotic cardiac surgical repair. JTCVS Tech 2024; 23:44-46. [PMID: 38351995 PMCID: PMC10859664 DOI: 10.1016/j.xjtc.2023.11.019] [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: 04/25/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Robinson Poffo
- Division of Cardiovascular Surgery, Instituto Poffo de Cirurgia Cardiovascular, São Paulo, Brazil
- Division of Cardiovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Henry Eiji Toma
- Division of Cardiovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Sergio Augusto Fudaba Curcio
- Division of Cardiovascular Surgery, Instituto Poffo de Cirurgia Cardiovascular, São Paulo, Brazil
- Division of Cardiovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Alisson Parrilha Toschi
- Division of Cardiovascular Surgery, Instituto Poffo de Cirurgia Cardiovascular, São Paulo, Brazil
- Division of Cardiovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Renato Bastos Pope
- Division of Cardiovascular Surgery, Instituto Poffo de Cirurgia Cardiovascular, São Paulo, Brazil
- Division of Cardiovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Leandro Echenique
- Division of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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4
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Tasoudis PT, Caranasos TG, Doulamis IP. Robotic applications for intracardiac and endovascular procedures. Trends Cardiovasc Med 2024; 34:110-117. [PMID: 36273775 DOI: 10.1016/j.tcm.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/01/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
The large incisions and long recovery periods that accompany traditional cardiac surgery procedures along with the constant patient demand for minimally invasive procedures have motivated cardiac surgeons to implement the robotic technologies in their armamentarium. The robotic systems have been utilized successfully in various cardiac procedures including atrial septal defect repair, left atrial myxoma resection, MAZE procedure and left ventricular lead placement, yet coronary artery bypass and mitral valve repair still comprise the vast majority of them. This review analyzes the development of the robot-assisted cardiac surgery in recent years, its outcomes, advantages, disadvantages, its patient selection criteria as well as its economic feasibility. Robotic endovascular surgery, albeit its limited applications, is presently considered an attractive alternative to conventional endovascular approaches. The increased flexibility and precision along with the wider range of accessible anatomy provided by the endovascular robotic systems, have increased the pool of patients that can be offered minimally invasive treatment options and have helped to overcome many limitations of the traditional endovascular procedures. With this review we aimed to summarize the applications of the commercially available endovascular robotic devices, as well as the limitations and the future perspectives in the field of endovascular robotic surgery.
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Affiliation(s)
- Panagiotis T Tasoudis
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, NC, United States
| | - Thomas G Caranasos
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, NC, United States
| | - Ilias P Doulamis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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5
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Seguchi R, Watanabe G, Ishikawa N, Kato Y, Miyagi M, Koakutsu T, Horikawa T, Miyayama N, Shigematsu S, Miyata K, Tomita S, Ohtsuka T. Outcomes of Barlow mitral valve repaired by robot-assisted keyhole surgery. JTCVS Tech 2023; 22:16-22. [PMID: 38152230 PMCID: PMC10750981 DOI: 10.1016/j.xjtc.2023.08.032] [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: 05/04/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 12/29/2023] Open
Abstract
Objective To present our strategy and the clinical outcomes of robot-assisted Barlow mitral valve keyhole surgery. Methods From May 2015 to March 2022, a total of 1281 patients underwent mitral valve repair at our institution, including 763 with robotics surgeries. Of these, 124 patients with Barlow mitral valve (49 ± 12 years, male/female ratio = 81:43) were treated using robotic assistance and included in this study. Results All operations were completed using 3 to 5 keyholes. Neochordae implantation using the loop technique was the first option, and resection was performed only in cases with an intrinsic risk of developing systolic anterior motion. Neochordae implantation was performed in 118 cases (95.1%) using 6.6 ± 3.0 neochordae. Posterior leaflet resection was performed in 27 (21.7%) patients. Operation time was 177 ± 42 minutes, cardiopulmonary bypass time was 127 ± 25 minutes, and aorta crossclamp time was 76 ± 16 minutes. Blood transfusion was required in 5 cases (4%). None of the patients required a conversion to valve replacement. The postoperative complications included bleeding (n = 4), stroke (n = 1), and infection (n = 2). Mitral valve regurgitation 1 week after repair was none or trivial in 122 cases (98.3%), mild in 2 cases (1.7%), and more than moderate in 0 cases. Freedom from reoperation was 99.2% during the follow-up period of 36 ± 21 months. One patient required reoperation due to infective endocarditis. Conclusions Robot-assisted keyhole surgery using the loop-first concept was adequate to help achieve satisfactory and safe perioperative outcomes for Barlow mitral valve.
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Affiliation(s)
- Ryuta Seguchi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Go Watanabe
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Norihiko Ishikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Yuki Kato
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Motomu Miyagi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Toru Koakutsu
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Takafumi Horikawa
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Naoki Miyayama
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Sayaka Shigematsu
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Kazuto Miyata
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Shigeyuki Tomita
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
| | - Toshiya Ohtsuka
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan
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6
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Issa HM, Rehman S, Burns D, Gillinov M, Hodges K. Tricks and tips to facilitate robotic approach for mitral valve repair. JTCVS Tech 2023; 22:84-85. [PMID: 38152209 PMCID: PMC10750885 DOI: 10.1016/j.xjtc.2023.09.020] [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: 07/30/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Hugo M.N. Issa
- Department of Thoracic and Cardiovascular Surgery, Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Syed Rehman
- Department of Thoracic and Cardiovascular Surgery, Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Burns
- Department of Thoracic and Cardiovascular Surgery, Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
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Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D, Rodriguez Cetina Biefer H, Dzemali O. Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery. J Clin Med 2023; 12:7210. [PMID: 38068262 PMCID: PMC10707549 DOI: 10.3390/jcm12237210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 06/26/2024] Open
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.
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Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
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8
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Yoshikawa Y, Kishimoto Y, Onohara T, Horie H, Kumagai K, Nii R, Kishimoto N, Morimoto K, Yoshikawa Y, Nishimura M. Safe launch of a robotically assisted mitral valve repair program in a single center: experience of initial 20 cases under the Center for Minimally Invasive Surgery. J Artif Organs 2023; 26:226-232. [PMID: 35969291 DOI: 10.1007/s10047-022-01348-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
Robotically assisted mitral valve repair was approved by the Japanese government in April 2018. However, understanding robotic surgery involves steep learning curves of surgeons and dedicated cardiac teams. The Center for Minimally Invasive Surgery (CMIS) of Tottori University Hospital is a multidisciplinary organization established in 2011 with seven surgical departments. In this study, we report strategies for improving the safety of robotic surgery in the CMIS and early results of robotic mitral valve repair at our hospital. We reviewed the first 20 patients who underwent robotic primary mitral valve repair, including concomitant procedures, from October 2019 to September 2021 under the supervision of the CMIS. Before starting the program, the CMIS requires setting console time limit to 180 min and implementing risk management strategies through simulation training for various mechanical failures. Mitral valve repair was completed in all patients. There was no in-hospital or 30-day mortality. No conversion to median sternotomy was necessary. The analysis of mitral pathology revealed 1 case of functional mitral regurgitation, 12 cases of posterior lesions, 3 cases of anterior lesions, 3 cases of bileaflet lesions, and 1 case of commissural lesion. The average cross-clamp time was 133 ± 27 min. Sixteen cases had trace mitral regurgitation postoperatively, and 4 cases had mild mitral regurgitation. The median (interquartile range) postoperative hospital stay was 10 (8.5-12.5) days. Robotically assisted mitral valve repair was performed safely with assistance from the multidisciplinary CMIS, and the early results were satisfactory without compromising clinical outcomes.
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Affiliation(s)
- Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Takeshi Onohara
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiromu Horie
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Nozomi Kishimoto
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kenichi Morimoto
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yuki Yoshikawa
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Department of Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
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Giroletti L, Brembilla V, Graniero A, Albano G, Villari N, Roscitano C, Parrinello M, Grazioli V, Lanzarone E, Agnino A. Learning Curve Analysis of Robotic-Assisted Mitral Valve Repair with COVID-19 Exogenous Factor: A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1568. [PMID: 37763687 PMCID: PMC10536190 DOI: 10.3390/medicina59091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background and objective Renewed interest in robot-assisted cardiac procedures has been demonstrated by several studies. However, concerns have been raised about the need for a long and complex learning curve. In addition, the COVID-19 pandemic in 2020 might have affected the learning curve of these procedures. In this study, we investigated the impact of COVID-19 on the learning curve of robotic-assisted mitral valve surgery (RAMVS). The aim was to understand whether or not the benefits of RAMVS are compromised by its learning curve. Materials and Methods Between May 2019 and March 2023, 149 patients underwent RAMVS using the Da Vinci® X Surgical System at the Humanitas Gavazzeni Hospital, Bergamo, Italy. The selection of patients enrolled in the study was not influenced by case complexity. Regression models were used to formalize the learning curves, where preoperative data along with date of surgery and presence of COVID-19 were treated as the input covariates, while intraoperative and postoperative data were analyzed as output variables. Results The age of patients was 59.1 ± 13.3 years, and 70.5% were male. In total, 38.2% of the patients were operated on during the COVID-19 pandemic. The statistical analysis showed the positive impact of the learning curve on the trend of postoperative parameters, progressively reducing times and other key indicators. Focusing on the COVID-19 pandemic, statistical analysis did not recognize an impact on postoperative outcomes, although it became clear that variables not directly related to the intervention, especially ICU hours, were strongly influenced by hospital logistics during COVID-19. Conclusions Understanding the learning curve of robotic surgical procedures is essential to ensure their effectiveness and benefits. The learning curve involves not only surgeons but also other health care providers, and establishing a stable team in the early stage, as in our case, is important to shorten the duration. In fact, an exogenous factor such as the COVID-19 pandemic did not affect the robotic program despite the fact that the pandemic occurred early in the program.
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Affiliation(s)
- Laura Giroletti
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Valentina Brembilla
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Ascanio Graniero
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Nicola Villari
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Matteo Parrinello
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Valentina Grazioli
- Cardiovascular Surgery Department, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy;
| | - Ettore Lanzarone
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Alfonso Agnino
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
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10
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Yoshikawa Y, Kishimoto Y, Onohara T, Kumagai K, Nii R, Sumi N, Kishimoto N, Ikeda Y, Yoshikawa Y, Yamane K, Nishimura M. Robot-Assisted Aortic Valve Replacement - First Clinical Report in Japan. Circ J 2023; 87:847-851. [PMID: 37062718 DOI: 10.1253/circj.cj-23-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Robot-assisted valve surgery represents the latest development in the field of minimally invasive approaches. Robotic assistance may provide greater visualization, enhanced dexterity, and greater precision than traditional mini-thoracotomy aortic valve replacement.Methods and Results: Aortic valve replacement operations using the da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) were performed on 2 patients, 1 with severe aortic insufficiency and the other with aortic stenosis. Both patients had an uneventful postoperative course and were discharged without any adverse events. CONCLUSIONS Robot-assisted assisted aortic valve replacement appears feasible and safe in limited cases.
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Affiliation(s)
- Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Takeshi Onohara
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Naoki Sumi
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Nozomi Kishimoto
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Yosuke Ikeda
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Yuki Yoshikawa
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Kazuma Yamane
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Tottori University Faculty of Medicine
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11
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Vardas P, DeLay TK, Stephens R, Abraham P, Lewis C. Robotic Redo Mitral Valve Replacement and Atrioventricular Groove Pseudoaneurysm Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:577-580. [PMID: 36539932 DOI: 10.1177/15569845221141706] [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: 12/24/2022]
Abstract
We report the use of robot-assisted right thoracotomy in the management of a patient who presented with acute-on-chronic congestive heart failure, associated with a contained atrioventricular dissection and 2 prior mitral valve replacements. Our patient had evidence of a contained rupture, as represented by preoperative cross-sectional imaging. The anatomic sequela from this was a ventricular pseudoaneurysm, which was likely survivable due to adhesions from prior operations buttressing the margins of the defect. Expansion of the pseudoaneurysm likely contributed to the dehiscence of the prosthesis. Our case illustrates an unprecedented resolution of a serious complication, managed effectively and efficiently by a robot-assisted procedure. With a successful outcome of totally endoscopic and robot-assisted repair, we demonstrate the versatility of minimally invasive techniques in addressing complicated anatomy as well as a surgical field scarred by multiple prior surgeries.
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Affiliation(s)
- Panayotis Vardas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Thomas Kurt DeLay
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Richard Stephens
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Peter Abraham
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Clifton Lewis
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, AL, USA
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12
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Agnino A, Graniero A, Villari N, Roscitano C, Gerometta P, Albano G, Anselmi A. Evaluation of robotic-assisted mitral surgery in a contemporary experience. J Cardiovasc Med (Hagerstown) 2022; 23:399-405. [PMID: 35645031 DOI: 10.2459/jcm.0000000000001319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To evaluate the safety/effectiveness of a recently established robotic-assisted mitral surgery program. METHODS Cohort study with prospective collection of clinical data of 59 consecutive recipients (May 2019-August 2021) of robotic-assisted (fourth-generation platform, DaVinci X) mitral valve repair for degenerative disease, using a totally endoscopic technique. Patients' selection was based on defined anatomical and clinical criteria. We established a dedicated multidisciplinary protocol to facilitate postoperative fast-tracking, and a systematic in-house clinical and echocardiographic follow-up at 3, 6, and 12 postoperative months. RESULTS All patients (89.8% men, average age 58 ± 12 years) received mitral valve repair; there was no operative mortality, one conversion to sternotomy (1.7%) and one stroke (1.7%). Extubation within the operative theater occurred in 28.8%; average mechanical ventilation time and ICU stay was 2.8 ± 4.1 and 32.5 ± 15.8 h (after exclusion of one outlier, learning-curve period, suffering from perioperative stroke); average postoperative hospital stay was 6.8 ± 3.4 days and 96.6% of patients were discharged home. One patient was transfused (1.7%); there were no other complications. Follow-up revealed stability of the results of mitral repair, with one (1.7%) persistent (>2+/4+) mitral regurgitation, and stability of coaptation height over time. We observed optimal functional results (class I was 98% at 3 months and 96% at 12 months). Quarterly case load consistently increased during the experience. CONCLUSION This initial experience suggests the reliability and clinical safety of a recently established local robotic-assisted mitral surgery. This strategy can facilitate faster postoperative recovery, and its positioning in the therapeutic armamentarium needs to be defined.
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Affiliation(s)
- Alfonso Agnino
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery
| | - Ascanio Graniero
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery
| | - Nicola Villari
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | | | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital.,Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
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Almeida A, Tutungi E, Moten S, Chen Y. Minimally invasive and robotic approaches to mitral valve: Robotic is best. JTCVS Tech 2021; 10:75-79. [PMID: 34977708 PMCID: PMC8691862 DOI: 10.1016/j.xjtc.2021.09.054] [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: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Aubrey Almeida
- Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Australia
- Cardiac Clinical Institute, Epworth Hospital, Melbourne, Australia
- Address for reprints: Aubrey Almeida, MBBS, FRACS, Department of Cardiothoracic Surgery, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168, Australia.
| | - Elli Tutungi
- Cardiac Clinical Institute, Epworth Hospital, Melbourne, Australia
| | - Simon Moten
- Cardiac Clinical Institute, Epworth Hospital, Melbourne, Australia
| | - Yi Chen
- Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Australia
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14
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Bonatti J, Kiaii B, Alhan C, Cerny S, Torregrossa G, Bisleri G, Komlo C, Guy TS. The role of robotic technology in minimally invasive surgery for mitral valve disease. Expert Rev Med Devices 2021; 18:955-970. [PMID: 34325594 DOI: 10.1080/17434440.2021.1960506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Robotic mitral valve surgery has developed for more than 20 years. The main purpose of robotic assistance is to use multiwristed instruments for surgical endothoracic maneuvers on the mitral valve without opening the chest. The surgeon controls the instruments remotely from a console but is virtually immersed into the operative field. AREAS COVERED This review outlines indications and contraindication for the procedure. Intra- and postoperative results as available in the literature are reported. Further areas focus on the technological development, advances in surgical techniques, training methods, and learning curves. Finally we give an outlook on the potential future of this operation. EXPERT OPINION Robotic assistance allows for the surgically least invasive form of mitral valve operations. All variations of robotic mitral valve repair and replacement are feasible and indications have recently been broadened. Improved dexterity of instrumentation, 3D and HD vision, introduction of a robotic left atrial retractor, and adjunct technology enable most complex forms of minimally invasive mitral valve interventions through ports on the patient's right chest wall. Application of robotics results in significantly reduced surgical trauma while maintaining safety and outcome standards in mitral valve surgery.
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Affiliation(s)
- Johannes Bonatti
- UPMC Heart and Vascular Institute and Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Main Line Health - Lankenau Heart Institute, Wynnewood, PA, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Caroline Komlo
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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15
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Amabile A, Komlo CM, Sloane Guy T. Showcasing the lateral approach for robotic aortic and mitral valve surgery: Does one approach fit it all? J Card Surg 2021; 36:3860-3861. [PMID: 34189761 DOI: 10.1111/jocs.15782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Amabile
- Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline M Komlo
- Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thomas Sloane Guy
- Department of Surgery, Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Image Data Security Mechanism Based on the Internet of Things Cardiac Catheterization Laboratory Information Management System Research and Design. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5592185. [PMID: 33884159 PMCID: PMC8041532 DOI: 10.1155/2021/5592185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/24/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
With the development of science and technology, more and more operations are performed in the cardiac catheterization laboratory. During such operations, a lot of relevant imaging data need to be retained. These imaging data can be used for clinical and scientific research and teaching applications, but imaging data security has also become an increasingly important issue. This article is based on the Internet of Things cardiac catheterization laboratory information management system image data security mechanism system research. First of all, this article adopts the literature method to study the application research of the Internet of Things technology in the medical field, as well as the relevant medical imaging data security technology methods. Then, the medical image data security mechanism was designed, and the image data security model of the cardiac catheterization laboratory information management system based on the Internet of Things was established. Finally, the application of decentralized management of the Internet of Things RFID technology on medical equipment and the security of the application of this technology on medical imaging data are analyzed, and finally a conclusion is drawn. The image data security mechanism established in this article is based on the Internet of Things technology. The security rate of image information data reaches more than 95%, the information data security level reaches level 1, and the average data missing rate is only 4.7%. It is a brand-new breakthrough, hoping to further improve the efficiency of hospital information management and protect the safety of medical information.
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17
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Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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18
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Zhou K, Yang L, He BC, Ke YJ, Yang YC, Yan Q, Chen ZR, Huang HL. Total thoracoscopic repair of ventricular septal defect: A single-center experience. J Card Surg 2021; 36:2213-2218. [PMID: 33783023 PMCID: PMC8252479 DOI: 10.1111/jocs.15504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/13/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Objectives To explore the safety and efficacy of total thoracoscopic repair of ventricular septal defects (VSD). We compared clinical outcomes of VSD via a total thoracoscopic approach with those of mini‐sternotomy. Methods We retrospectively reviewed clinical data from patients with VSD from 2012 to January 2019. According to the surgical pattern, they were divided into two groups: the total thoracoscopic surgery group (36 patients, 27 females, aged 29 ± 9.52 years), and a mini‐sternotomy group (31 patients, 12 females, aged 28 ± 8.67 years). Results There were no deaths in either group. In the thoracoscopic group, cardiopulmonary bypass (CPB) time and aortic cross‐clamping (ACC) time were significantly longer than those of the mini‐sternotomy group (CPB time: 112 ± 23.16 min vs. 78 ± 37.90 min, respectively, p < .001; ACC time: 65 ± 19.94 min vs. 50 ± 24.90 min, respectively, p < .001). postoperative hospital stay time (5.11 ± 2.48 days vs. 5.90 ± 6.27 days, p = .488) and chest drainage (139.86 ± 111.71 ml vs. 196.13 ± 147.34 ml, p = .081) tended to be lower in the thoracoscopy group, although there was no significant difference. No residual shunt or tricuspid regurgitation was found at follow‐up. Conclusions Total thoracoscopic repair is safe and effective in patients with VSD, with or without tricuspid regurgitation.
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Affiliation(s)
- Kan Zhou
- Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong Province, China
| | - Liang Yang
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Biao-Chuan He
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China
| | - Ying-Jie Ke
- Nanhai Hospital of Guangdong Provincial People's Hospital, Guangdong, China
| | - Yan-Chen Yang
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China
| | - Qian Yan
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China
| | - Ze-Rui Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China
| | - Huan-Lei Huang
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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19
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Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. Rev Port Cardiol 2021; 40:293-304. [PMID: 33745777 DOI: 10.1016/j.repc.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022] Open
Abstract
Degenerative mitral valve disease (myxomatous degeneration or fibroelastic deficiency) is the most common indication for surgical referral to treat mitral regurgitation. Mitral valve repair is the procedure of choice whenever feasible and when the results are expected to be durable. Posterior leaflet prolapse is the commonest lesion, found in up to two-thirds of patients. It is the easiest to repair, particularly when limited to one segment. In these cases, rates of repairability and procedural success approach 100%, and there is now ample evidence that the immediate and long-term results are better than those of valve replacement. Notably, minimally invasive valvular procedures, surgical or interventional, have attracted increasing interest in the last decade. When performed by experienced groups, mitral valve repair is unrivaled irrespective of the severity of lesions, from simple to complex, which leaflets are involved, and the type of degenerative involvement (myxomatous or fibroelastic). Its results should be viewed as the benchmark for other present and future technologies. By contrast, percutaneous mitral valve repair is still in its infancy and its results so far fall short of those of surgical repair. Nevertheless, continued investment in transcatheter procedures is of great importance to enable development and improved accessibility, particularly for patients who are considered unsuitable for surgery. In this review, we analyze the current status of management of degenerative mitral valve disease, discussing mitral valve anatomy and pathology, indications for intervention, and current surgical and transcatheter mitral valve procedures and results.
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Affiliation(s)
- Gonçalo F Coutinho
- Cardiothoracic Surgery Department, University Hospital and Center of Coimbra, Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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20
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Hamandi M, Hafen L, Squiers JJ, Lanfear AT, DiMaio JM, Smith RL. A Review of Robotic Mitral Valve Surgery. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2020.1866230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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21
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Barac YD, Loungani RS, Sabulsky R, Zwischenberger B, Gaca J, Carr K, Glower DD. Robotic versus port-access mitral repair: A propensity score analysis. J Card Surg 2021; 36:1219-1225. [PMID: 33462900 DOI: 10.1111/jocs.15342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Port-access (PORT) and robotic (ROBO) mitral repair are well established, but differences in patient selection and outcomes are not well documented. METHODS A retrospective analysis was performed on 129 ROBO and 628 PORT mitral repairs at one institution. ROBO patients had 4 cm nonrib spreading incisions with robotic assistance, while PORT patients had 6-8 cm rib spreading incisions with thoracoscopic assistance. Propensity score analysis matched patients for differences in baseline characteristics. RESULTS Unmatched ROBO patients were younger (58 ± 11 vs. 61 ± 13, p = .05), had a higher percentage of males (77% vs. 63%, p = .003) and had less NYHA Class 3-4 symptoms (11% vs. 21%, p < .01), less atrial fibrillation (19% vs. 29%, p = .02) and less tricuspid regurgitation (14% vs. 24%, p = .01). Propensity score analysis of matched patients showed that pump time (275 ± 57 vs. 207 ± 55, p < .0001) and clamp time (152 ± 38 vs. 130 ± 34, p < .0001) were longer for ROBO patients. However, length of stay, postoperative morbidity, and 5-year survival (97 ± 1% vs. 96 ± 3%, p = .7) were not different. For matched patients with degenerative valve disease, 5-year incidence of mitral reoperation (3 ± 2% vs. 1 ± 1%), severe mitral regurgitation (MR) (6 ± 4% vs. 1 ± 1%), or ≥2 + MR (12 ± 5% vs. 12 ± 4%), were not significantly different between ROBO versus PORT approaches. Predictors of recurrent moderate MR were connective tissue disease, functional etiology, and non-White race, but not surgical approach. CONCLUSIONS In this first comparison out to 5 years, robotic versus port-access approach to mitral repair had longer pump and clamp times. Perioperative morbidity, 5-year survival, and 5-year repair durability were otherwise similar.
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Affiliation(s)
- Yaron D Barac
- Rabin Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Jeffrey Gaca
- Duke University Medical Center, Durham, North Carolina, USA
| | - Keith Carr
- Duke University Medical Center, Durham, North Carolina, USA
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22
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Commentary: Striking the right chord. J Thorac Cardiovasc Surg 2021; 164:1831-1832. [PMID: 33563420 DOI: 10.1016/j.jtcvs.2021.01.002] [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: 12/30/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 11/20/2022]
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23
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Tang RC, Murphy DA, Moss E. Choosing the Ideal Candidate for a Robotic Valve Intervention. Can J Cardiol 2021; 37:1117-1120. [PMID: 33434611 DOI: 10.1016/j.cjca.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022] Open
Abstract
Robotic cardiac surgery addressing the mitral and tricuspid valves is a highly developed field offering multiple potential advantages regarding postoperative complications, valve repair rates, hospital length of stay, and rapid functional recovery compared with the conventional sternotomy approach for select patients. The unparalleled stereoscopic view within the heart and precision of robotic arms make robotic surgery a highly attractive minimally invasive approach, facilitating repair of even the most complex valvular pathology. Careful candidate selection and surgical planning are paramount to optimising the outcomes of those who undergo robotic valve surgery. As a team's experience grows, the technique can be applied to a wider range of patients that may derive even greater benefit, such as those with significant comorbid conditions, ventricular dysfunction, and previous sternotomy. The goal of this review is to provide clinicians with a practical overview of the factors influencing a patient's candidacy for robotic valve surgery. We discuss key issues such as preoperative diagnostic assessment, concerns regarding demographics and surgical pathology, and additional considerations relating to surgical exposure, cardiopulmonary bypass, and myocardial protection. Diligent patient assessment and a strong team-based approach are paramount to developing and maintaining a successful robotic valve surgery program, with the most seasoned teams being able to safely offer the technique to the vast majority of patients referred for mitral or tricuspid valve repair or replacement.
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Affiliation(s)
- Richard C Tang
- Division of Cardiac Surgery, McGill University, Montréal, Québec, Canada
| | - Douglas A Murphy
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emmanuel Moss
- Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
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24
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Liu K, Sun H, Wang B, Ma H, Ma B, Ma Z. Is tri-port totally thoracoscopic surgery for mitral valve replacement a feasible approach? Ann Cardiothorac Surg 2021; 10:149-157. [PMID: 33575185 DOI: 10.21037/acs-2020-mv-fs-0064] [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: 11/06/2022]
Abstract
Background Minimally invasive cardiac surgery is an attractive approach for both surgeons and patients. This study aims to describe the experience of mitral valve replacement (MVR) with Ma's tri-port totally thoracoscopic cardiac surgery technique (MTCST) and to prove the feasibility and safety of this technique. Methods A total of 490 consecutive patients undergoing MVR were divided into MTCST group (MT group, n=267) and conventional median sternotomy group (MS group, n=223). The perioperative characteristics and the follow-up information were recorded and analyzed between the two groups. Results The in-hospital mortality and re-operation rate were not significant between the two groups. Compared with the MS group, cardiopulmonary bypass time and aortic cross-clamp time were both longer in the MT group while total operative time was similar to the MS group. Patients in the MT group had less pain and required a decreased analgesic administration than that in the MS group. Intraoperative blood loss, perioperative blood transfusion and the postoperative drainage were all significantly reduced in the MT group as compared to the MS group. Mechanical ventilation time, ICU duration, hospitalization time and hospitalization cost were decreased in the MT group. Patients undergoing MVR with MTCST had a higher Medical Treatment Satisfactory Score than those with conventional sternotomy. Conclusions MTCST for mitral valve disease was technically safe and feasible. The results showed that MTCST was a suitable minimally invasive alternative to the conventional sternotomy approach and was a desirable approach for patients with mitral valve disease.
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Affiliation(s)
- Kai Liu
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hourong Sun
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Biao Wang
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongliang Ma
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bingbing Ma
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zengshan Ma
- Department of Cardiovascular Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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25
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Chemtob RA, Wierup P, Mick SL, Javorski MJ, Burns DJP, Blackstone EH, Svensson LG, Gillinov AM. A conservative screening algorithm to determine candidacy for robotic mitral valve surgery. J Thorac Cardiovasc Surg 2020; 164:1080-1087. [PMID: 33436297 DOI: 10.1016/j.jtcvs.2020.12.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Patient selection for robotically assisted mitral valve repair remains controversial. We assessed outcomes of a conservative screening algorithm developed to select patients with degenerative mitral valve disease for robotic surgery. METHODS From January 2014 to January 2019, a screening algorithm that included transthoracic echocardiography and computed tomography scanning was rigorously applied by 3 surgeons to assess candidacy of 1000 consecutive patients with isolated degenerative mitral valve disease (age 58 ± 11 years, 67% male) for robotic surgery. Screening results and hospital outcomes of those selected for robotic versus sternotomy approaches were compared. RESULTS With application of the screening algorithm, 605 patients were selected for robotic surgery. Common reasons for sternotomy (n = 395) were aortoiliac atherosclerosis (n = 74/292, 25%), femoral artery diameter <7 mm (n = 60/292, 20%), mitral annular calcification (n = 83/390, 21%), aortic regurgitation (n = 100/391, 26%), and reduced left ventricular function (n = 126/391, 32%). Mitral valve repair was accomplished in 996. Compared with sternotomy, patients undergoing robotic surgery had less new-onset atrial fibrillation (n = 144/582, 25% vs n = 125/373, 34%; P = .002), fewer red blood cell transfusions (n = 61/601, 10% vs 69/395, 17%; P < .001), and shorter hospital stay (5.2 ± 2.9 days vs 5.9 ± 2.1 days; P < .001). No hospital deaths occurred, and occurrence of postoperative stroke in the robotic (n = 3/605, 0.50%) and sternotomy (n = 4/395, 1.0%; P = .3) groups was similar. CONCLUSIONS This conservative screening algorithm qualified 60% of patients with isolated degenerative mitral valve disease for robotic surgery. Outcomes were comparable with those obtained with sternotomy, validating this as an approach to select patients for robotic mitral valve surgery.
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Affiliation(s)
- Raphaelle A Chemtob
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Per Wierup
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie L Mick
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael J Javorski
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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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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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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Schaff HV, Nguyen A. Contemporary techniques for mitral valve repair-the Mayo Clinic experience. Indian J Thorac Cardiovasc Surg 2020; 36:18-26. [PMID: 33061182 DOI: 10.1007/s12055-019-00801-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022] Open
Abstract
Mitral valve repair for patients with degenerative or functional mitral valve regurgitation improves symptoms and prognosis, and several techniques have been described. Important principles in operation are simplicity, reproducibility, and durability of repair. At Mayo Clinic, we have operated on more than 6000 patients with degenerative mitral valve disease and valve prolapse, and this review details our approach to mitral valve repair, including robotic and minimally invasive techniques. Most patients with isolated leaflet prolapse can be managed with leaflet plication or triangular resection, and chordal replacement is reserved for repair of anterior leaflet prolapse. Posterior annuloplasty with a standard-sized flexible band is used to reduce annular circumference and improve leaflet coaptation. With these methods, early risk of mortality for mitral valve repair is low in the current era (< 1%), and rate of recurrent valve leakage is 1.5 per 100 patient-years during the first year post-repair and 0.9 per 100 patient-years thereafter. This paper also briefly summarizes important considerations for patients with mitral valve regurgitation and severe calcification, perforations due to endocarditis, and rheumatic heart disease.
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Affiliation(s)
- Hartzell Vernon Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Anita Nguyen
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
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Merkle-Storms J, Liakopoulos OJ. Commentary: Mitral valve repair using adjustable posterior leaflet neochords. JTCVS Tech 2020; 2:56-57. [PMID: 34317751 PMCID: PMC8298850 DOI: 10.1016/j.xjtc.2020.01.022] [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: 12/09/2019] [Revised: 12/13/2019] [Accepted: 01/02/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Julia Merkle-Storms
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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30
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Early results of robotically assisted mitral valve repair in a single institution: report of the first 100 cases. Gen Thorac Cardiovasc Surg 2020; 68:1079-1085. [DOI: 10.1007/s11748-020-01317-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
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Yajima S, Fukushima S, Kakuta T, Fujita T. Robotic mitral valve repair for rheumatic mitral stenosis and regurgitation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 32128486 PMCID: PMC7047053 DOI: 10.1093/ehjcr/ytz240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/17/2019] [Accepted: 12/19/2019] [Indexed: 11/15/2022]
Abstract
Background Rheumatic mitral valve (MV) disease is the major cause of congestive cardiac failure in children and young adults, particularly in developing countries. Mitral valve repair with minimum prosthetic material is the gold standard treatment for this condition. However, MV repair for rheumatic MV disease is known to be technically demanding. Case summary A 27-year-old woman without a history of cardiac disease presented with dyspnoea on exertion. Echocardiography revealed rheumatic severe mitral stenosis and regurgitation, with thickening of the bileaflets, doming of the anterior leaflet, shortening of the posterior leaflet, fusions of the lateral and particularly the medial commissure, and enlargement of the mitral annulus. We successfully performed robot-assisted MV repair with bicommissural release, patch augmentation of the two leaflets, and implantation of an originally sized partial band. Discussion Robotic MV repair can contribute to precise valve inspection and operative procedures. This approach seems feasible for complex rheumatic MV disease particularly in young patients.
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Affiliation(s)
- Shin Yajima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka 565-8565, Japan
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Duan JS, Sun T, Ge SL, Zhang CX, Liu Z, Gong Q. A case of abdominal bleeding after mitral valvuloplasty assisted by da Vinci robotic surgery. J Card Surg 2020; 35:683-685. [PMID: 31971268 DOI: 10.1111/jocs.14413] [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: 11/29/2022]
Abstract
A 66-year-old female patient was admitted with abdominal bleeding as an unexpected complication of robotic surgery. Assessments included the patient's medical history, physical examination, laboratory data, and abdominal ultrasound scan results. In our case, laparotomy revealed an injury to the diaphragm and liver of the patient caused by the previous robotic surgery. In conclusion, although abdominal bleeding is a rare condition, it should be taken into consideration as a complication of robotic cardiac surgery.
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Affiliation(s)
- Jing-Si Duan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tao Sun
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Sheng-Lin Ge
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Cheng-Xin Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhuang Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qian Gong
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Nagaoka E, Gelinas J, Vola M, Kiaii B. Early Clinical Experiences of Robotic Assisted Aortic Valve Replacement for Aortic Valve Stenosis with Sutureless Aortic Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:88-92. [DOI: 10.1177/1556984519894298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Robotic assisted aortic valve surgery is still challenging and debatable. We retrospectively reviewed our cases of robotic assisted aortic valve replacement utilizing sutureless aortic valve with following surgical technique: 3 ports, 1 for endoscope and 2 for the robotic arms were inserted in the right chest and da Vinci Si robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was adapted to these ports. Cardiopulmonary bypass was initiated through peripheral cannulations. A vent cannula was placed through the right superior pulmonary vein and a cardioplegia cannula in the ascending aorta. After cardioplegic arrest following aortic cross-clamp, the aortic valve was exposed through a clam shell aortotomy. Valvectomy along with decalcification was performed. Next using 3 guiding sutures the Perceval S valve (LivaNova, London, UK) was parachuted down and deployed. After confirming valve position, the aortotomy was closed. There were no major complications during the procedures and no conversion to sternotomy. Exposure of aortic valve was of high quality. Valvectomy required assistance with long scissors by the bedside surgeon for excision of the severely calcified valve cusps and effective decalcification of annulus. Postoperative convalescence was uncomplicated except for postoperative atrial fibrillation in 1 patient. Robotic assistance in aortic valve procedure enabled excellent exposure of the aortic valve and improved manipulation and suturing of the aortic annulus and aorta. There needs to be improvement of instrumentation for valve debridement and removal of calcium from the annulus. In addition, the sutureless valve technology contributes to the feasibility and the efficacy of this procedure.
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Affiliation(s)
- Eiki Nagaoka
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Jill Gelinas
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Marco Vola
- Department of Cardiac Surgery, University Hospital of Lyon, France
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
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Maltais S, Anwer LA, Daly RC, Poddi S, Topilsky Y, Enrique-Sarano M, Michelena HI, Mauermann WJ, Dearani JA. Robotic Mitral Valve Repair: Indication for Surgery Does Not Influence Early Outcomes. Mayo Clin Proc 2019; 94:2263-2269. [PMID: 31635830 DOI: 10.1016/j.mayocp.2019.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/09/2019] [Accepted: 05/01/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the outcomes of robotic mitral valve repair (MVr) by primary indication per American Heart Association guidelines for surgery: class I vs class IIa. PATIENTS AND METHODS From January 1, 2008, through September 30, 2016, 603 patients underwent robotic MVr for severe primary mitral regurgitation. Medical records of 576 consenting patients were retrospectively reviewed to determine the primary indication for surgery. Patients were stratified into class I or class IIa, and preoperative, intraoperative, and postoperative variables were compared. RESULTS Of 516 patients, 428 (83%) had class I indication and 88 (17%) had class IIa indication for surgery. Preoperatively, no significant differences were observed between both cohorts. Importantly, a significantly higher number of patients with class I indication underwent MVr for bileaflet prolapse (172 of 428 [40%] vs 21 of 88 [25%]; P=.03). Early MVr outcomes indicated recurrent mitral regurgitation (moderate or greater) in only 12 of 576 (2%), and no significant differences were observed between classes (P=.23). Apart from parameters for ventricular size, all other intraoperative and postoperative variables were comparable between both cohorts. CONCLUSION Comparable outcomes were indicated across all classes of indications for MVr surgery. These results continue to support the use of this surgical technique, even in less sick patients. Early referral along with more extensive robotic MVr experience will likely result in further improvements in long-term outcomes.
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Affiliation(s)
- Simon Maltais
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
| | - Lucman A Anwer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; Department of General Surgery, University of Illinois/Metropolitan Group of Hospitals, Chicago
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Salvatore Poddi
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Yan Topilsky
- Department of Cardiovascular Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
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35
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Research on motion pattern recognition of exoskeleton robot based on multimodal machine learning model. Neural Comput Appl 2019. [DOI: 10.1007/s00521-019-04567-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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36
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Tarui T, Ishikawa N, Horikawa T, Seguchi R, Shigematsu S, Kiuchi R, Miyata K, Tomita S, Ohtake H, Watanabe G. First Major Clinical Outcomes of Totally Endoscopic Robotic Mitral Valve Repair in Japan ― A Single-Center Experience ―. Circ J 2019; 83:1668-1673. [DOI: 10.1253/circj.cj-19-0284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tatsuya Tarui
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute
| | | | | | - Ryuta Seguchi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute
| | | | - Ryuta Kiuchi
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute
| | - Kazuto Miyata
- Department of Anesthesia, NewHeart Watanabe Institute
| | - Shigeyuki Tomita
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute
| | - Hiroshi Ohtake
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute
| | - Go Watanabe
- Department of Cardiovascular Surgery, NewHeart Watanabe Institute
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Kesävuori R, Vento A, Lundbom N, Schramko A, Jokinen JJ, Raivio P. Minimal volume ventilation during robotically assisted mitral valve surgery. Perfusion 2019; 34:705-713. [PMID: 31090485 DOI: 10.1177/0267659119847917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION A minimal volume ventilation method for robotically assisted mitral valve surgery is described in this study. In an attempt to reduce postoperative pulmonary dysfunction, 40 of 174 patients undergoing robotically assisted mitral valve surgery were ventilated with a small tidal volume during cardiopulmonary bypass. METHODS After propensity score matching, 31 patients with minimal volume ventilation were compared with 54 patients with no ventilation. Total ventilation time, PaO2/FiO2 ratio, arterial lactate concentration, and the rate of unilateral pulmonary edema in the matched minimal ventilation and standard treatment groups were evaluated. RESULTS Patients in the minimal ventilation group had shorter ventilation times, 12.0 (interquartile range: 9.9-15.0) versus 14.0 (interquartile range: 12.0-16.3) hours (p = 0.036), and lower postoperative arterial lactate levels, 0.99 (interquartile range: 0.81-1.39) versus 1.28 (interquartile range: 0.99-1.86) mmol/L (p = 0.01), in comparison to patients in the standard treatment group. There was no difference in postoperative PaO2/FiO2 ratio levels or in the rate of unilateral pulmonary edema between the groups. CONCLUSION Minimal ventilation appeared beneficial in terms of total ventilation time and blood lactatemia, while there was no improvement in arterial blood gas measurements or in the rate of unilateral pulmonary edema. The lower postoperative arterial lactate levels may suggest improved lung perfusion among patients in the minimal volume ventilation group. The differences in the ventilation times were in fact small, and further studies are required to confirm the possible advantages of the minimal volume ventilation method in robotically assisted cardiac surgery.
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Affiliation(s)
- Risto Kesävuori
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Vento
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Nina Lundbom
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Alexey Schramko
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Janne J Jokinen
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Peter Raivio
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Chitwood WR. Robotic Mitral Valve Repair: How I Teach It. Ann Thorac Surg 2019; 107:1297-1301. [PMID: 30898565 DOI: 10.1016/j.athoracsur.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- W Randolph Chitwood
- Department of Cardiovascular Sciences, Brody School of Medicine, Vidant Medical Center and East Carolina University, Greenville, North Carolina.
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Kilic A, Acker MA, Gleason TG, Sultan I, Vemulapalli S, Thibault D, Ailawadi G, Badhwar V, Thourani V, Kilic A. Clinical Outcomes of Mitral Valve Reoperations in the United States: An Analysis of The Society of Thoracic Surgeons National Database. Ann Thorac Surg 2018; 107:754-759. [PMID: 30365952 DOI: 10.1016/j.athoracsur.2018.08.083] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluated outcomes of reoperative mitral valve surgery (MVS) in the United States. METHODS Adults undergoing isolated MVS with prior open-heart operation in The Society of Thoracic Surgeons (STS) National Database between July 2011 and September 2016 were included. Urgent or emergent operations as well as all indications and causes for MVS were included. Primary outcomes were operative mortality and morbidity. Multivariable models were used for risk-adjustment, incorporating variables from the STS Valve Risk Model as well as type of prior operation and reoperative approach. RESULTS A total of 17,195 patients underwent isolated reoperative MVS at 962 centers. The STS predicted risk of mortality was 8.0%, with 20% having an STS predicted risk of mortality greater than 10%. Prior cardiac operations included previous MVS (61%), coronary artery bypass (39%), aortic valve surgery (18%), and tricuspid valve surgery (6%). Operative mortality for the overall study cohort was 6.6%, and postoperative stroke occurred in 2.4%. Observed-to-expected mortality for the overall cohort was 0.82. The strongest independent predictors of operative mortality included salvage operation, preoperative dialysis dependence, congestive heart failure, recent myocardial infarction, and active endocarditis. Prior aortic valve replacement was associated with increased mortality risk, whereas prior MVS reduced mortality risk. Surgical approach did not affect mortality. For patients with prior MVS undergoing elective, non-endocarditis operations, the operative mortality was 3.4%. CONCLUSIONS Despite a high-risk patient profile, surgical outcomes of reoperative MVS were acceptable, particularly in patients with prior MVS and without endocarditis undergoing elective operations.
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Affiliation(s)
- Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Michael A Acker
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Dylan Thibault
- Duke Clinical Research Institute, Durham, North Carolina
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Vinod Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Washington, DC
| | - Ahmet Kilic
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
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Abstract
Mitral valve (MV) insufficiency, classified as primary and secondary mitral regurgitation (MR), is a common cause of morbidity and mortality. In industrialized countries, degenerative forms are the predominant cause of MR; however, an increasing number of patients present with secondary MR (Iung et al. EHJ 24:1231-1243, 2003). During the last decades, MV surgery experienced substantial advancements. Alain Carpentier pioneered the field of reconstructive valve surgery in the beginning of the 1970s and, since then, a plethora of innovations have led to today's landscape of MV surgery. Modern MV repair techniques including minimally invasive approaches represent the gold standard for primary MR with reconstruction rates of > 97% in high-volume reference centers (Castillo et al. JTCS 144(2):308-312, 2012). Although there is a clear strategy for treatment of primary MR with established high-quality results, the optimal course for treatment of secondary MR remains controversial. Results for a variety of MV repair techniques for secondary MR have been uniformly disappointing and there has been a recent resurgence in interest for MV replacement surgery. Innovations in equipment and imaging have led to the development of new techniques for patients with MV disease. High-risk patients who are poor candidates for surgery have been the focus for most of these techniques, usually within the construct of a multidisciplinary heart team. Efforts have been predominantly focused on less invasive strategies, usually transcatheter technologies, in these high-risk patients. This article aims to give an overview about current surgical treatment options for primary and for secondary MR with special focus on new surgical and transcatheter developments.
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Affiliation(s)
- Sabine Meier
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Joerg Seeburger
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany.
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41
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Chen CW, Atluri P. Robotic mitral valve surgery: Additive benefits without additive cost. J Thorac Cardiovasc Surg 2018; 156:1038-1039. [PMID: 29941165 DOI: 10.1016/j.jtcvs.2018.05.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Carol W Chen
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
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42
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Robotic mitral valve repair. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-018-0666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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43
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Simple versus complex degenerative mitral valve disease. J Thorac Cardiovasc Surg 2018; 156:122-129.e16. [PMID: 29709354 DOI: 10.1016/j.jtcvs.2018.02.102] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 01/28/2018] [Accepted: 02/23/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES At a center where surgeons favor mitral valve (MV) repair for all subsets of leaflet prolapse, we compared results of patients undergoing repair for simple versus complex degenerative MV disease. METHODS From January 1985 to January 2016, 6153 patients underwent primary isolated MV repair for degenerative disease, 3101 patients underwent primary isolated MV repair for simple disease (posterior prolapse), and 3052 patients underwent primary isolated MV repair for complex disease (anterior or bileaflet prolapse), based on preoperative echocardiographic images. Logistic regression analysis was used to generate propensity scores for risk-adjusted comparisons (n = 2065 matched pairs). Durability was assessed by longitudinal recurrence of mitral regurgitation and reoperation. RESULTS Compared with patients with simple disease, those undergoing repair of complex pathology were more likely to be younger and female (both P values < .0001) but with similar symptoms (P = .3). The most common repair technique was ring/band annuloplasty (3055/99% simple vs 3000/98% complex; P = .5), followed by leaflet resection (2802/90% simple vs 2249/74% complex; P < .0001). Among propensity-matched patients, recurrence of severe mitral regurgitation 10 years after repair was 6.2% for simple pathology versus 11% for complex pathology (P = .007), reoperation at 18 years was 6.3% for simple pathology versus 11% for complex pathology, and 20-year survival was 62% for simple pathology versus 61% for complex pathology (P = .6). CONCLUSIONS Early surgical intervention has become more common in patients with degenerative MV disease, regardless of valve prolapse complexity or symptom status. Valve repair was associated with similarly low operative risk and time-related survival but less durability in complex disease. Lifelong annual echocardiographic surveillance after MV repair is recommended, particularly in patients with complex disease.
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44
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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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Wang H, Boyd JH. How to start a successful robotic mitral surgery program: It's not just about the surgery! J Thorac Cardiovasc Surg 2018; 155:1472-1473. [DOI: 10.1016/j.jtcvs.2017.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022]
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Gillinov AM, Mihaljevic T, Javadikasgari H, Suri RM, Mick SL, Navia JL, Desai MY, Bonatti J, Khosravi M, Idrees JJ, Lowry AM, Blackstone EH, Svensson LG. Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases. J Thorac Cardiovasc Surg 2018; 155:82-91.e2. [DOI: 10.1016/j.jtcvs.2017.07.037] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 02/07/2023]
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Robotic surgery: Maximizing the potential of a minimally invasive platform. J Thorac Cardiovasc Surg 2017; 155:947-948. [PMID: 29223843 DOI: 10.1016/j.jtcvs.2017.11.014] [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: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 11/23/2022]
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Dearani JA. Robotic heart surgery: Hype or hope? J Thorac Cardiovasc Surg 2017; 155:943-944. [PMID: 29108717 DOI: 10.1016/j.jtcvs.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/20/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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Preoperative determination of artificial chordae length with 320-slice computed tomographic images. J Thorac Cardiovasc Surg 2017; 154:1634-1637. [DOI: 10.1016/j.jtcvs.2017.06.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/31/2017] [Accepted: 06/26/2017] [Indexed: 11/21/2022]
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