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Murphy DA, Psarev S, Jonnson AA, Halkos ME. Endoscopic Robotic Mitral Operating Room as a Microsystem for Safety and Sustainability. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241278605. [PMID: 39301877 DOI: 10.1177/15569845241278605] [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: 09/22/2024]
Abstract
OBJECTIVE Safety and sustainability are key elements of a robotic mitral valve (MV) program at any stage of development. Challenges include the positioning of the surgeon at the robotic console, increasing patient complexity, and upstream administrative staffing difficulties. We instituted a systems approach to maximize patient safety and maintain robotic service viability. METHODS A single dedicated robotic operating room (OR) was equipped as a microsystem with team training in the operative steps, ergonomics, digital tools, and an explicit culture of safety. Outcomes of all robotic mitral procedures including concomitant procedures in the microsystem OR by a single surgeon were retrospectively reviewed. RESULTS From January 2014 through December 2023, 1,529 consecutive MV patients were operated with an endoscopic robotic approach. Ten patients (0.65%) were converted to conventional approaches. Overall, 1,300 MV repairs (85%) were performed with residual MV regurgitation of none to trace in 1,205 patients (92.7%), mild in 92 patients (7.1%), and moderate in 3 patients (0.23%). MV replacements were performed in 229 patients (15%) with no paravalvular leaks. Mortality was 0.08% in the repair group and 0.87% in the replacement group. No deaths have occurred in the last 38 months. Stroke occurred in 0.31% of repair patients and 1.3% of replacement patients. One patient developed transient renal failure. CONCLUSIONS Organization of the robotic OR as a microsystem is associated with surgical efficacy and very low morbidity and mortality. A comparable microsystem approach using all or select components may promote safety and sustainability for robotic MV programs at all levels.
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Affiliation(s)
- Douglas A Murphy
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sergey Psarev
- Department of Biomedical Engineering, Emory Saint Joseph's Hospital, Atlanta, GA, USA
| | - Amalia A Jonnson
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Mascherbauer J, Kammerlander A, Nitsche C, Bax J, Delgado V, Evangelista A, Laroche C, Maggioni AP, Magne J, Vahanian A, Iung B. Sex-related differences in severe native valvular heart disease: the ESC-EORP Valvular Heart Disease II survey. Eur Heart J 2024:ehae523. [PMID: 39212374 DOI: 10.1093/eurheartj/ehae523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/08/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND AIMS To assess sex differences in disease characteristics and treatment of patients with severe native valvular heart disease (VHD) included in the VHD II EURObservational Research Programme. METHODS A total of 5219 patients were enrolled in 208 European and North African centres and followed for 6 months [41.2% aortic stenosis (AS), 5.3% aortic regurgitation (AR), 4.5% mitral stenosis (MS), 21.3% mitral regurgitation (MR), 2.7% isolated right-sided VHD, 24.9% multiple left-sided VHD]. Indications for intervention were considered concordant if corresponding to class I recommendations specified in the 2012 ESC or 2014 AHA/ACC VHD guidelines. RESULTS Overall, women were older, more symptomatic, and presented with a higher EuroSCORE II. Bicuspid aortic valve and AR were more prevalent among men while mitral disease, concomitant tricuspid regurgitation (TR), and AS above age 65 were more prevalent among women. On multivariable regression analysis, concordance with recommended treatment was significantly poorer in women with MS and primary MR (both P < .001). Age, patient refusal, and decline of symptoms after conservative treatment were reported significantly more often as reasons to withhold the intervention in females. Concomitant tricuspid intervention was performed at a similar rate in both sexes although prevalence of significant TR was significantly higher in women. In-hospital and 6-month survival did not differ between sexes. CONCLUSIONS (i) Valvular heart disease subtype varied between sexes; (ii) concordance with recommended intervention for MS and primary MR was significantly lower for women; and (iii) survival of men and women was similar at 6 months.
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Affiliation(s)
- Julia Mascherbauer
- Department of Internal Medicine 3, University Hospital St. Pölten, Dunantplatz 1, 3100 St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Andreas Kammerlander
- Department of Internal Medicine 2, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Department of Internal Medicine 2, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Heart Institute, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | | | - Julien Magne
- Department of Cardiology, Dupuytren University Hospital 2, Limoges, France
| | | | - Bernard Iung
- Bichat Hospital, APHP, and INSERM LVTS 1148, Université Paris-Cité, Paris, France
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3
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Halkos ME, Jonsson A, Badhwar V, Balkhy HH, Grossi EA, Dearani JA, Geirsson A, Gillinov M, Melnitchouk S, Loulmet D, Murphy DA. Developing Proficiency in Robotic Cardiac Surgery. Ann Thorac Surg 2024:S0003-4975(24)00691-X. [PMID: 39209092 DOI: 10.1016/j.athoracsur.2024.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 05/23/2024] [Accepted: 07/15/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The purpose of this review is to provide recommendations for cardiac surgeons interested in adopting a robotic platform into their programs. METHODS The recommendations are based on the experience of the authors and cover a diverse array of cardiac surgical procedures that are currently performed with robotic assistance. The focus, as with any innovative surgical approach, is to ensure patient safety, maximize quality and efficacy, and set realistic expectations about what is required to achieve proficiency in robotic cardiac surgery. RESULTS Even though there may be steady growth in robotic cardiac procedures, it is possible that these procedures will be concentrated in higher-volume programs that already offer expertise in mitral valve or coronary surgery. Once success and proficiency with robotic cardiac approaches to coronary or valvular heart disease is achieved, as outlined in this review, surgeons may wish to embark on more complex robotic procedures, such as reoperative mitral valve surgery, totally endoscopic coronary artery bypass, or aortic valve replacement. CONCLUSIONS Maintaining the same principles and techniques for coronary surgery or intracardiac procedures and maintaining the fundamentals of myocardial protection and cardiopulmonary bypass are essential to ensure excellent technical and clinical outcomes and to optimize patient safety.
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Affiliation(s)
- Michael E Halkos
- Division of Cardiothoracic Surgery, Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia.
| | - Amalia Jonsson
- Division of Cardiothoracic Surgery, Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Husam H Balkhy
- Division of Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, New York University, New York, New York
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arnar Geirsson
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Didier Loulmet
- Department of Cardiothoracic Surgery, New York University, New York, New York
| | - Douglas A Murphy
- Division of Cardiothoracic Surgery, Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia
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4
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Hahn RT. Sex-related differences in degenerative mitral regurgitation: a call to action. Eur Heart J 2024; 45:2317-2319. [PMID: 38866496 DOI: 10.1093/eurheartj/ehae360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
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Perri JL, Nguyen TC. Advanced Fellowships After Training: Super or Not? Thorac Surg Clin 2024; 34:9-15. [PMID: 37953058 DOI: 10.1016/j.thorsurg.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Advanced training in cardiothoracic surgery has become more prevalent in the setting of increased complexity of interventions. Minimally invasive techniques, transcatheter and endovascular interventions, and rapid growth in mechanical circulatory support and transplant have led approximately 40% of trainees to pursue additional training. Available data suggest trainees seek additional training for 3 main reasons: gain an additional skillset, improve candidacy for a job, and/or increase proficiency in basic areas. This review provides an analysis of existing literature, categorized by specialty (cardiac, thoracic, and congenital) to determine areas where additional training is of benefit.
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Affiliation(s)
- Jennifer L Perri
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, UCSF Medical Center, 500 Parnassus Avenue, MUW 405, Box 0118, San Francisco, CA 94143, USA.
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6
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Rehman SM, Hodges K, Burns DJ, Gillinov M. Robotic artificial chord implantation for repair of extensive noncontiguous posterior mitral leaflet prolapse. JTCVS Tech 2023; 22:73-74. [PMID: 38152167 PMCID: PMC10750878 DOI: 10.1016/j.xjtc.2023.08.028] [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: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Syed M. Rehman
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Daniel J.P. Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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Kawano Y, MacGillivray T. Broader application of robotic platform to complex mitral cases. JTCVS Tech 2023; 22:103-104. [PMID: 38152182 PMCID: PMC10750817 DOI: 10.1016/j.xjtc.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Yuji Kawano
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Thomas MacGillivray
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC
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8
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Mick SL, Kohlbacher B, Gillinov AM. Robotic mitral valve repair: The steps to success. JTCVS Tech 2023; 22:49-52. [PMID: 38152222 PMCID: PMC10750819 DOI: 10.1016/j.xjtc.2023.08.023] [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: 07/31/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Stephanie L. Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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9
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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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Tomšič A, Palmen M. Robotic mitral valve repair surgery: where do we go from here? Front Cardiovasc Med 2023; 10:1156495. [PMID: 37293277 PMCID: PMC10244781 DOI: 10.3389/fcvm.2023.1156495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Surgical mitral valve repair through median sternotomy has long presented the treatment of choice for degenerative mitral valve disease. In recent decades, minimal invasive surgical techniques have been developed and are now gaining widespread popularity. Robotic cardiac surgery presents an emerging field, initially adopted only by selected centres, mostly in the United States. In recent years, the number of centers interested in robotic mitral valve surgery has grown with an increasing adoption in Europe as well. Increasing interest and surgical experience gained are stimulating further developments in the field and the full potential of robotic mitral valve surgery remains to be developed.
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11
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Al Shamry A, Jegaden M, Ashafy S, Eker A, Jegaden O. Minithoracotomy versus sternotomy in mitral valve surgery: meta-analysis from recent matched and randomized studies. J Cardiothorac Surg 2023; 18:101. [PMID: 37024952 PMCID: PMC10080824 DOI: 10.1186/s13019-023-02229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/02/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND There is still ongoing debate about the benefits of mini-thoracotomy (MTH) approach in mitral valve surgery in comparison with complete sternotomy (STER). This study aims to update the current evidence with mortality as primary end point. METHODS The MEDLINE and EMBASE databases were searched through June 2022. Two randomized studies and 16 propensity score matched studies published from 2011 to 2022 were included with a total of 12,997 patients operated on from 2005 (MTH: 6467, STER: 6530). Data regarding early mortality, stroke, reoperation for bleeding, new renal failure, new onset of atrial fibrillation, need of blood transfusion, prolonged ventilation, wound infection, time-related outcomes (cross clamp time, cardiopulmonary bypass time, ventilation time, length of intensive care unit stay, length of hospital stay), midterm mortality and reoperation, and costs were extracted and submitted to a meta-analysis using weighted random effects modeling. RESULTS The incidence of early mortality, stroke, reoperation for bleeding and prolonged ventilation were similar, all in the absence of heterogeneity. However, the sub-group analysis showed a significant OR in favor of MTH when robotic enhancement was used. New renal failure (OR 1.67, 95% CI 1.06-2.62, p = 0.03), new onset of atrial fibrillation (OR 1.31, 95% CI 1.15-1.51, p = 0.001) and the need of blood transfusion (OR 1.77, 95% CI 1.39-2.27, p = 0.001) were significantly lower in MTH group. Regarding time-related outcomes, there was evidence for important heterogeneity of treatment effect among the studies. Operative times were longer in MTH: differences in means were 20.7 min for cross clamp time (95% CI 14.9-26.4, p = 0.001), 36.8 min for CPB time (95% CI 29.8-43.9, p = 0.001) and 37.7 min for total operative time (95% CI 19.6-55.8, p < 0.001). There was no significant difference in ventilation duration; however, the differences in means showed significantly shorter ICU stay and hospital stay after MTH compared to STER: - 0.6 days (95% CI - 1.1/- 0.21, p = 0.001) and - 1.88 days (95% CI - 2.72/- 1.05, p = 0.001) respectively, leading to a significant lower hospital cost after MTH compared to STER with difference in means - 4528 US$ (95% CI - 8725/- 326, p = 0.03). The mid-term mortality was significantly higher after STER compared to MTH: OR = 1.50, 1.09-2.308 (95% CI), p = 0.01; the rate of mid-term reoperation was reported similar in MTH and STER: OR = 0.76, 0.50-1.15 (95% CI), p = 0.19. CONCLUSIONS The present meta-analysis confirms that the MTH approach for mitral valve disease remains associated with prolonged operative times, but it is beneficial in terms of reduced postoperative complications (renal failure, atrial fibrillation, blood transfusion, wound infection), length of stay in ICU and in hospitalization, with finally a reduction in global cost. MTH approach appears associated with a significant reduction of postoperative mortality that must be confirmed by large randomized study.
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Affiliation(s)
- Adel Al Shamry
- Department of Cardiac Surgery and ICU, Saudi German Hospital, Dubai, UAE
| | - Margaux Jegaden
- Department of Surgery, Kremlim Bicetre Hospital, Paris, France
| | - Salah Ashafy
- Department of Cardiac Surgery, Zayed Military Hospital, Abu Dhabi, UAE
| | - Armand Eker
- Department of Cardiac Surgery, Centre Cardio-Thoracic, Monaco, Monaco
| | - Olivier Jegaden
- Department of Cardiac Surgery, Mediclinic Middle East, Mediclinic Airport Road Hospital, MBRU, PO Box 48481, Abu Dhabi, UAE.
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Chitwood WR. Historical evolution of robot-assisted cardiac surgery: a 25-year journey. Ann Cardiothorac Surg 2022; 11:564-582. [PMID: 36483613 PMCID: PMC9723535 DOI: 10.21037/acs-2022-rmvs-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/05/2022] [Indexed: 08/18/2023]
Abstract
Many patients and surgeons today favor the least invasive access to an operative site. The adoption of robot-assisted cardiac surgery has been slow, but now has come to fruition. The development of modern surgical robots took surgeons close collaboration with mechanical, electrical, and optical engineers. Moreover, the necessary project funding required entrepreneurs, federal grants, and venture capital. Non-robotic minimally invasive cardiac surgery paved the way to the application of surgical robots by making changes in operative approaches, instruments, visioning modalities, cardiopulmonary perfusion techniques, and especially surgeons' attitudes. In this article, the serial development of robot-assisted cardiac surgery is detailed from the beginning and through clinical application. Included are references to the historical and most recent clinical series that have given us the evidence that robot-assisted cardiac surgery is safe and provides excellent outcomes. To this end, in many institutions these procedures now have become a new standard of care. This evolution reflects Sir Isaac Newton's famous 1676 quote when referring to Rene Descartes, "If have seen further [sic] than others, it is by standing on the shoulders of giants".
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Affiliation(s)
- W Randolph Chitwood
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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13
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Sex-Related Factors in Valvular Heart Disease. J Am Coll Cardiol 2022; 79:1506-1518. [DOI: 10.1016/j.jacc.2021.08.081] [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: 05/26/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022]
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Meidan TG, Lanfear AT, Squiers JJ, Hamandi M, Lytle BW, DiMaio JM, Smith RL. Robotic Mitral Valve Surgery After Prior Sternotomy. JTCVS Tech 2022; 13:46-51. [PMID: 35711230 PMCID: PMC9196136 DOI: 10.1016/j.xjtc.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Despite the recent increase in the use of minimally invasive approaches to mitral valve surgery in patients with a prior sternotomy, the outcomes of the robotic approach to mitral valve surgery in this patient population have not been examined. Methods We retrospectively reviewed 342 consecutive patients who underwent mitral valve surgery after a prior sternotomy between 2013 and 2020, in which the robotic approach was used in 21 patients (6.1%). We reviewed the clinical details of these 21 patients. Results The median age was 71 years [interquartile range 64.00, 74.00 years], and mean Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% ± 3.8%. The indication for mitral valve surgery was degenerative mitral valve disease in 33.3% (7/21), functional disease in 28.6% (6/21), mixed disease in 4.8% (1/21), rheumatic disease in 9.5% (2/21), and failed repair for degenerative disease in 23.8% (5/21). No cases required conversion from robotic assistance to alternative approaches, there were no intraoperative deaths, and intraoperative transesophageal echocardiogram confirmed complete elimination of mitral regurgitation in 90.5% (19/21) of cases. Thirty-day mortality was 0.0% (0/21), and 1-year mortality was 4.8% (1/21). There were no strokes or wound infections at 30 days, and 14.3% (3/21) of patients received intraoperative blood product transfusions. Conclusions The results of this retrospective review suggest that the robotic approach to mitral valve surgery in patients with a prior sternotomy is safe in experienced hands. Although some centers have considered prior sternotomy a relative contraindication to robotic mitral valve surgery, this approach is feasible and can be considered an option for experienced surgeons.
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Affiliation(s)
- Talia G. Meidan
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
- Address for reprints: Talia G. Meidan, BS, Baylor Scott & White The Heart Hospital – Plano, 1100 Allied Dr, Plano, TX 75093.
| | - Allison T. Lanfear
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - John J. Squiers
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Mohanad Hamandi
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Bruce W. Lytle
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - J. Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Robert L. Smith
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
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Hodges K, Burns D, Gillinov AM, Suri R. Commentary: Surgical treatment of atrial fibrillation at the time of cardiac surgery: Just do it. JTCVS Tech 2021; 10:82-83. [PMID: 34984365 PMCID: PMC8691930 DOI: 10.1016/j.xjtc.2021.10.018] [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: 10/12/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - A. Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Rakesh Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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16
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Johnston DR, Gillinov AM. Is there a "one size fits all" minimally invasive approach for valve surgery? Ann Thorac Surg 2021; 114:727. [PMID: 34780771 DOI: 10.1016/j.athoracsur.2021.09.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Douglas R Johnston
- Cleveland Clinic, Thoracic and Cardiovascular Surgery, 9500, Euclid Ave, J-4-480, Cleveland, OH 44195.
| | - A Marc Gillinov
- Cleveland Clinic, Thoracic and Cardiovascular Surgery, 9500, Euclid Ave, J-4-480, Cleveland, OH 44195
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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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18
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Mehaffey JH, Hawkins RB. Commentary: Robotic mitral valve surgery selection criteria: Screening algorithm or quantifying selection bias? J Thorac Cardiovasc Surg 2021; 164:1088-1089. [PMID: 33500132 DOI: 10.1016/j.jtcvs.2020.12.053] [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: 12/07/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Affiliation(s)
- J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va.
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
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19
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Nafday HB, Grossi EA. Commentary: Reap what you sew: Excellent advice for a conservative algorithm for robotic mitral surgery. J Thorac Cardiovasc Surg 2020; 164:1090-1091. [PMID: 33526276 DOI: 10.1016/j.jtcvs.2020.12.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Heidi B Nafday
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY.
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20
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Hameed I, Geirsson A. Commentary: Building a successful robotic mitral surgery program-one size does not fit all. J Thorac Cardiovasc Surg 2020; 164:1089-1090. [PMID: 33461806 DOI: 10.1016/j.jtcvs.2020.12.065] [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: 12/12/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Irbaz Hameed
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
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