1
|
Cirugía coronaria de mínima invasión: técnicas y resultados. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
|
2
|
Gofus J, Cerny S, Shahin Y, Sorm Z, Vobornik M, Smolak P, Sethi A, Marcinov S, Karalko M, Chek J, Harrer J, Vojacek J, Pojar M. Robot-assisted vs. conventional MIDCAB: A propensity-matched analysis. Front Cardiovasc Med 2022; 9:943076. [PMID: 36110419 PMCID: PMC9468449 DOI: 10.3389/fcvm.2022.943076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Robotic assistance (RA) in the harvesting of internal thoracic artery during minimally invasive direct coronary artery bypass grafting (MIDCAB) provides several potential benefits for surgeon and patient in comparison with conventional MIDCAB. The two technical options have not been thoroughly compared in the literature yet. We aimed to perform this in our cohort with the use of propensity-score matching (PSM). Methods This was a retrospective comparison of all consecutive patients undergoing conventional MIDCAB (2005–2021) and RA-MIDCAB (2018–2021) at our institution with the use of PSM with 27 preoperative covariates. Results Throughout the study period 603 patients underwent conventional and 132 patients underwent RA-MIDCAB. One hundred and thirty matched pairs were selected for further comparison. PSM successfully eliminated all preoperative differences. Patients after RA-MIDCAB had lower 24 h blood loss post-operatively (300 vs. 450 ml, p = 0.002). They had shorter artificial ventilation time (6 vs. 7 h, p = 0.018) and hospital stay (6 vs. 8 days, p < 0.001). There was no difference in the risk of perioperative complications, short-term and mid-term mortality between the groups. Conclusions RA-MIDCAB is an attractive alternative to conventional MIDCAB. It is associated with lower post-operative blood loss and potentially faster rehabilitation after surgery. The mortality and the risk of perioperative complications are comparable among the groups.
Collapse
|
3
|
Spanjersberg A, Hoek L, Ottervanger JP, Nguyen TY, Kaplan E, Laurens R, Singh S. Early home discharge after robot-assisted coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2022; 35:ivac134. [PMID: 35554537 PMCID: PMC9245385 DOI: 10.1093/icvts/ivac134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Robot-assisted coronary artery bypass grafting (CABG) has been developed as a less invasive alternative for conventional CABG to enhance postoperative recovery, patient satisfaction and early discharge to home. Furthermore, it may provide a basis for hybrid coronary revascularization. To determine the feasibility of this procedure, we compared robot-assisted with conventional off-pump CABG. METHODS All consecutive patients undergoing a robot-assisted left internal mammary artery-to-left anterior descending coronary artery procedure were compared to consecutive patients undergoing conventional off-pump CABG for single-vessel disease from October 2016 to July 2019. The primary outcome was discharge to home within 5 days after the operation. Secondary outcomes were total hospital stay, reoperations within 48 h, transfusions, atrial fibrillation, 30-day mortality and quality of life 1 month postoperatively. A propensity matched cohort was assembled to correct for possible confounders. RESULTS A total of 107 patients who had robot-assisted CABG were compared to 194 patients who had conventional off-pump CABG. The primary outcome was reached in 51% of the robot-assisted group versus 19% of the conventional off-pump group (P < 0.01). The median postoperative hospital stay was 5 days for the robot-assisted group versus 7 days in the conventional off-pump group (P < 0.01). Other secondary outcomes did not differ significantly between the groups, and the quality of life 1 month after the operation was equal. The results after propensity matching were similar. CONCLUSIONS Early discharge to home is more frequent for patients who have robot-assisted CABG than in those who have conventional off-pump CABG, with no difference in health-related quality of life. Therefore, this approach may reduce healthcare resources and provide a solid basis for hybrid coronary revascularization.
Collapse
Affiliation(s)
- Alexander Spanjersberg
- Division Cardiothoracic Anesthesiology: Department of Anesthesiology and Intensive Care, Isala Heart Centre, Isala Zwolle, Netherlands
| | - Leendert Hoek
- ICON, Early development services, Groningen, Netherlands
| | | | - Thi-Yen Nguyen
- Division Cardiothoracic Anesthesiology: Department of Anesthesiology and Intensive Care, Isala Heart Centre, Isala Zwolle, Netherlands
| | | | - Roland Laurens
- Department of Cardiothoracic Surgery, Isala Heart Centre, Isala Zwolle, Netherlands
| | - Sandeep Singh
- Department of Cardiothoracic Surgery, Isala Heart Centre, Isala Zwolle, Netherlands
| |
Collapse
|
4
|
Liang L, Ma X, Kong Q, Xiao W, Liu J, Chi L, Zhu J. Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: a single-center retrospective cohort study. Cardiovasc Diagn Ther 2022; 12:378-388. [PMID: 35800361 PMCID: PMC9253167 DOI: 10.21037/cdt-22-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/25/2022] [Indexed: 09/05/2023]
Abstract
BACKGROUND This present research was designed for comparing coronary artery disease (CAD) patient outcomes following minimally invasive coronary artery bypass grafting surgery (MICS) or coronary artery bypass grafting (CABG). METHODS From 2014-2017, 679 CAD patients underwent MICS (n=281) or CABG (n=398) and were evaluated for the present study. Patient data were analyzed using 1:1 propensity score-matched assessment and a multivariate Cox proportional hazards regression model, and primary study achievements comprised major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), cardiac death, heart failure (HF), revascularization, and stroke. The median follow-up period was 2.68 years. RESULTS CABG patients exhibited a trend towards higher cumulative overall rates of MACCEs at 2 years (CABG: 6.2% vs. MICS: 3.8%) and 4 years (CABG: 9.3% vs. MICS: 7.6%) [adjusted hazard ratio (HR): 1.33; 95% confidence interval (CI): 0.33-5.39 for CABG vs. MICS; P=0.687], although this difference was not significant. No significant differences in 2- or 4-year cardiac death rates were observed between groups (CABG: 3.5%, 5.6% vs. MICS 2.8%, 2.8%; adjusted HR: 0.23; 95% CI: 0.03-1.81 for CABG vs. MICS; P=0.160). Further, there existed no discrepancies in rates of MI (P=1.000), HF (adjusted HR: 4.76; 95% CI: 0.01-6.40 for CABG vs. MICS; P=0.996), stroke (adjusted HR: 9.58; 95% CI: 0.11-25.24 for CABG vs. MICS; P=0.320), or repeated revascularization (adjusted HR: 1.71; 95% CI: 0.01-7.21 for CABG vs. MICS; P=0.631) when comparing these patient groups. In a multivariable Cox proportional hazards regression analysis, patients that were male (adjusted HR: 5.28; 95% CI: 1.48-18.83; P=0.010) and cases with a history of previous MI epsiodes (adjusted HR: 3.20; 95% CI: 1.09-9.37; P=0.034) were found to be at a higher risk of MACCEs. CONCLUSIONS Follow-up data indicated that the MICS and CABG treatments could achieve similar outcomes.
Collapse
Affiliation(s)
- Lin Liang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qingyu Kong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Xiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiaji Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liqun Chi
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junming Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis 2021; 13:1922-1944. [PMID: 33841980 PMCID: PMC8024818 DOI: 10.21037/jtd-20-1535] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra- and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.
Collapse
Affiliation(s)
- Johannes Bonatti
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Stephanie Wallner
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Ingo Crailsheim
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Bernhard Winkler
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
Abusamra R, Król M, Milewski K, Kachel M, Abudaqa L, Jankowska-Sanetra J, Derbisz K, Sanetra K, Sobieszek A, Buszman PP, Wojakowski W, Buszman PE, Bochenek A, Cisowski M. Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis. Cardiol J 2019; 28:86-94. [PMID: 30701513 DOI: 10.5603/cj.a2019.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/07/2018] [Accepted: 01/08/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To perform a retrospective analysis of patients who underwent endoscopic atraumatic coronary artery off-pump bypass grafting (EACAB) in a single center over a period of 11 years. METHODS Data was acquired from the hospital registry and patient medical records. In order to determine changes in clinical profile, patients were subdivided into three groups regarding year of surgery: 1998-2002 (group 1), 2003-2005 (group 2), 2006-2009 (group 3). In-hospital analysis up to 30 days and long-term observation were conducted. RESULTS The study cohort consisted of 714 patients (581 male). Procedural success accounted for 99% of all patients. No mortality was observed up to 30 days. Complications in the early period included pleural effusion (7.6%), cardiac arrhythmias (3.6%), bleeding related revision (2.7%) and wound infection (1.6%). Mean follow-up was 6 years (2132 ± 1313 days; median: 1918.5). Nineteen (2.7%) patients died, of which 52.6% (10 patients) were due to heart related conditions. Overall frequency of major adverse cerebral and cardiovascular events (MACCE) was 10.8% (77 patients). The Kaplan-Meyer analysis defined survival rate and event-free survival in long-term observation of 96.1% and 85.3%, respectively. Ejection fraction (EF) < 50% was the only independent factor of mortality (OR: 3.35). Regarding cumulative MACCE, older age (OR: 1.72), lower EF (OR: 3.03), the history of percutaneous coronary intervention (OR: 2.13) and higher New York Heart Association class (OR: 2.63) influenced the incidence rate. CONCLUSIONS The presented short and very long-term results confirm that EACAB is an efficient alternative for patients requiring revascularization of the left anterior descending artery. The elimination of cardiopulmonary bypass significantly reduces the number of complications.
Collapse
Affiliation(s)
- Rafik Abusamra
- Al Zahra Hospital Sharjah, United Arab Emirates.,Medical University of Silesia, Katowice, Poland
| | - Marek Król
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Mateusz Kachel
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.
| | | | - Justyna Jankowska-Sanetra
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Kamil Derbisz
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Krzysztof Sanetra
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Anna Sobieszek
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Piotr P Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | | | - Paweł E Buszman
- Medical University of Silesia, Katowice, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland
| | - Andrzej Bochenek
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,Medical University of Silesia, Katowice, Poland
| | - Marek Cisowski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland, Poland.,Medical University of Silesia, Katowice, Poland
| |
Collapse
|
7
|
Long-Term Outcome of Patients Undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery: A Single-Center Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:23-28. [PMID: 29462051 DOI: 10.1097/imi.0000000000000466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective was to investigate the long-term survival of patients who underwent single-vessel coronary revascularization with minimally invasive direct coronary artery bypass surgery with or without hybrid revascularization. The secondary outcome measures were repeat revascularization either by coronary artery bypass grafting or by percutaneous coronary intervention and the incidence of myocardial infarction or recurrent angina. METHODS This is a retrospective study of prospectively collected data of patients who underwent minimally invasive direct coronary artery bypass procedure in our center between January 2001 and December 2015. Procedures were performed either through small left anterolateral thoracotomy or lower midline sternotomy. RESULTS A total of 182 patients were identified: 100 underwent minimally invasive direct coronary artery bypass to the left anterior descending artery and 82 underwent hybrid revascularization (percutaneous coronary intervention to coronary arteries other than the left anterior descending artery along with minimally invasive direct coronary artery bypass to the left anterior descending artery). The mean ± SD age was 62 ± 10.1 years. Preoperatively 82% were male, and 72.5% patients had good left ventricular function. The median follow-up period was 10.9 years. There was no in-hospital or 30-day mortality. The 10-year actuarial survival was 84.8%. Freedom from repeat revascularization was 98.9% at 1 year and 89.9% at 10 years. At follow-up, freedom from myocardial infarction was 96.7% whereas freedom from angina was 92.9%. CONCLUSIONS Within the limitations imposed by retrospective analyses, our study demonstrates excellent long-term outcome in patients undergoing minimally invasive direct coronary artery bypass with or without hybrid revascularization. For isolated left anterior descending artery disease minimally invasive direct coronary artery bypass should be considered, whereas hybrid revascularization (percutaneous coronary intervention and minimally invasive direct coronary artery bypass) should be considered for multivessel disease.
Collapse
|
8
|
Podemska-Jedrzejczak Z, Malinska A, Sujka-Kordowska P, Nowicki M, Puslecki M, Jemielity M, Perek B. Vascular restenosis in coronary artery bypass grafting might be associated with VEGF-C/VEGFR-3 signaling pathway. Heart Vessels 2018; 33:1106-1120. [PMID: 29557990 PMCID: PMC6096743 DOI: 10.1007/s00380-018-1158-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
Abstract
The vascular endothelial growth factor (VEGF) family of peptides and caveolins (CAVs) are reported to contribute, in early graft failure in patients, a coronary artery bypass grafting (CABG). To investigate the possible association of ultimate luminal occlusion to VEGFs and CAVs expression, a functional analysis (based on the molecular biology, bioinformatics, histology, and clinical studies) was performed. Twenty-four hundred and sixty-eight CABG patients diagnosed with multivessel stable coronary artery disease (CAD) were enrolled into prospective study and assigned to two subgroups: double- and triple-vessel CAD subjects. Distal parts of all the harvested saphenous vein (SV) and internal thoracic artery (ITA) segments were used for further tests. ITA graft failure did not differ between double-vessel and triple-vessel CAD patients. The number of SV occlusions was significantly higher in triple-vessel CAD subjects. The microarray analysis performed on SV and ITA samples obtained exclusively from triple-vessel CAD patients who developed early graft occlusion revealed 383 genes with increased and 301 genes with decreased expression in ITA samples as compared to SV grafts. This was followed by functional analysis of ‘blood vessel development’ group of genes. Average VEGF-C expression in ITA grafts was higher than in corresponding SV grafts; FLT4 expression was significantly higher in SV than in ITA transplants. VEGFR-3 and CAV3 expression demonstrated immunohistochemically in SMCs of the tunica media of SV grafts predicted their early restenosis in triple-vessel CAD patients. CAV2 protein expression in SMCs of ITA grafts indicated the risk of early graft failure both in double-vessel and triple-vessel CAD subjects.
Collapse
Affiliation(s)
- Zuzanna Podemska-Jedrzejczak
- Department of Histology and Embryology, Poznan University of Medical Sciences, Swiecickiego 6 St, 60-781, Poznan, Poland
| | - Agnieszka Malinska
- Department of Histology and Embryology, Poznan University of Medical Sciences, Swiecickiego 6 St, 60-781, Poznan, Poland.,Department of Anatomy and Histology, University of Zielona Gora, Zyty 28 St, 65-046, Zielona Gora, Poland
| | - Patrycja Sujka-Kordowska
- Department of Histology and Embryology, Poznan University of Medical Sciences, Swiecickiego 6 St, 60-781, Poznan, Poland. .,Department of Anatomy and Histology, University of Zielona Gora, Zyty 28 St, 65-046, Zielona Gora, Poland.
| | - Michal Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, Swiecickiego 6 St, 60-781, Poznan, Poland
| | - Mateusz Puslecki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Dluga 1/2 St, 60-101, Poznan, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Dluga 1/2 St, 60-101, Poznan, Poland
| | - Bartlomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Dluga 1/2 St, 60-101, Poznan, Poland
| |
Collapse
|
9
|
Farid S, Ali JM, Stohlner V, Alam R, Schofield P, Nashef S, De Silva R. Long-Term Outcome of Patients Undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shakil Farid
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Jason M. Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Victoria Stohlner
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Ruhina Alam
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Peter Schofield
- Department of Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Ravi De Silva
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| |
Collapse
|
10
|
Medical robots in cardiac surgery - application and perspectives. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:79-83. [PMID: 28515758 PMCID: PMC5404137 DOI: 10.5114/kitp.2017.66939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/12/2017] [Indexed: 11/17/2022]
Abstract
Medical robots offer new standards and opportunities for treatment. This paper presents a review of the literature and market information on the current situation and future perspectives for the applications of robots in cardiac surgery. Currently in the United States, only 10% of thoracic surgical procedures are conducted using robots, while globally this value remains below 1%. Cardiac and thoracic surgeons use robotic surgical systems increasingly often. The goal is to perform more than one hundred thousand minimally invasive robotic surgical procedures every year. A surgical robot can be used by surgical teams on a rotational basis. The market of surgical robots used for cardiovascular and lung surgery was worth 72.2 million dollars in 2014 and is anticipated to reach 2.2 billion dollars by 2021. The analysis shows that Poland should have more than 30 surgical robots. Moreover, Polish medical teams are ready for the introduction of several robots into the field of cardiac surgery. We hope that this market will accommodate the Polish Robin Heart robots as well.
Collapse
|
11
|
Minimally invasive surgical techniques in the era of hybrid coronary revascularization: additional benefits for the elderly patients? JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:875-879. [PMID: 27928232 PMCID: PMC5131205 DOI: 10.11909/j.issn.1671-5411.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Cao C, Indraratna P, Doyle M, Tian DH, Liou K, Munkholm-Larsen S, Uys C, Virk S. A systematic review on robotic coronary artery bypass graft surgery. Ann Cardiothorac Surg 2016; 5:530-543. [PMID: 27942485 DOI: 10.21037/acs.2016.11.08] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Robotic-assisted coronary artery bypass graft surgery (CABG) has been performed over the past decade. Despite encouraging results from selected centres, there is a paucity of robust clinical data to establish its clinical safety and efficacy. The present systematic review aimed to identify all relevant clinical data on robotic CABG. The primary endpoint was perioperative mortality, and secondary endpoints included perioperative morbidities, anastomotic complications, and long-term survival. METHODS Electronic searches were performed using three online databases from their dates of inception to 2016. Relevant studies fulfilling the predefined search criteria were categorized according to surgical techniques as (I) totally endoscopic coronary artery bypass without cardiopulmonary bypass (TECAB off-pump); (II) TECAB on-pump; and robotic-assisted mammary artery harvesting followed by minimally invasive direct coronary artery bypass (robotic MIDCAB). RESULTS The present systematic review identified 44 studies that fulfilled the study selection criteria, including nine studies in the TECAB off-pump group and 16 studies in the robotic MIDCAB group. Statistical analysis reported a pooled mortality of 1.7% for the TECAB off-pump group and 1.0% for the robotic MIDCAB group. Intraoperative details such as the number and location of grafts performed, operative times and conversion rates, as well as postoperative secondary endpoints such as morbidities, anastomotic complications and long-term outcomes were also summarized for both techniques. CONCLUSIONS A number of technical, logistic and cost-related issues continue to hinder the popularization of the robotic CABG procedure. Current clinical evidence is limited by a lack of randomized controlled trials, heterogeneous definition of techniques and complications, as well as a lack of robust clinical follow-up with routine angiography. Nonetheless, the present systematic review reported acceptable perioperative mortality rates for selected patients at specialized centres. These results should be considered as a useful benchmark for future studies, until further data is reported in the form of randomized trials.
Collapse
Affiliation(s)
- Christopher Cao
- The Collaborative Research (CORE) group, Macquarie University, Sydney, Australia;; Department of Cardiothoracic Surgery, St. George Hospital, Sydney, Australia
| | - Praveen Indraratna
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia;; University of New South Wales, Sydney, Australia
| | - Mathew Doyle
- Department of Cardiothoracic Surgery, St. George Hospital, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) group, Macquarie University, Sydney, Australia;; Royal North Shore Hospital, Sydney, Australia
| | - Kevin Liou
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | | | - Ciska Uys
- Department of Cardiothoracic Surgery, St. George Hospital, Sydney, Australia
| | - Sohaib Virk
- The Collaborative Research (CORE) group, Macquarie University, Sydney, Australia
| |
Collapse
|