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Massey J, Palmer K, Al-Rawi O, Chambers O, Ridgway T, Shanmuganathan S, Soppa G, Modi P. Robotic mitral valve surgery. Front Cardiovasc Med 2024; 10:1239742. [PMID: 38505666 PMCID: PMC10948479 DOI: 10.3389/fcvm.2023.1239742] [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: 06/13/2023] [Accepted: 10/19/2023] [Indexed: 03/21/2024] Open
Abstract
Totally endoscopic robotic mitral valve repair is the least invasive surgical therapy for mitral valve disease. Robotic mitral valve surgery demonstrates faster recovery with shorter hospital stays, less morbidity, and equivalent mortality and mid-term durability compared to sternotomy. In this review, we will explore the advantages and disadvantages of robotic mitral valve surgery and consider important technical details of both operative set-up and mitral valve repair techniques. The number of robotic cardiac surgical procedures being performed globally is expected to continue to rise as experience grows with robotic techniques and increasing numbers of cardiac surgeons become proficient with this innovative technology. This will be facilitated by the introduction of newer robotic systems and increasing patient demand.
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Affiliation(s)
| | | | | | | | | | | | | | - Paul Modi
- Department of Cardiothoracic Surgery, The Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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2
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Fatehi Hassanabad A, Nagase FNI, Basha AM, Hammal F, Menon D, Kent WDT, Ali IS, Nagendran J, Stafinski T. A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:471-481. [PMID: 36529985 PMCID: PMC9846568 DOI: 10.1177/15569845221141488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy. METHODS A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible. RESULTS The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches. CONCLUSIONS Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada,Ali Fatehi Hassanabad, MD, MSc, Section of
Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute,
Foothills Medical Center, 1403, 29th Street NW, Calgary, Alberta, T2N2T9,
Canada.
| | - Fernanda N. I. Nagase
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ameen M. Basha
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Fadi Hammal
- School of Public Health, University of
Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Imtiaz S. Ali
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department
of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton,
AB, Canada
| | - Tania Stafinski
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
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3
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Reparación robótica de la válvula mitral. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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4
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Klepper M, Noirhomme P, de Kerchove L, Mastrobuoni S, Spadaccio C, Lemaire G, El Khoury G, Navarra E. Robotic mitral valve repair: A single center experience over a 7-year period. J Card Surg 2022; 37:2266-2277. [PMID: 35510407 DOI: 10.1111/jocs.16575] [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: 07/03/2021] [Revised: 08/21/2021] [Accepted: 09/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND We report the clinical and echocardiographic results of our experience in robotic mitral valve repair over a 7-year period. The outcomes of the earliest and the latest patients will be compared. METHODS Between March 2012 and October 2019, 226 patients underwent robotic mitral valve repair for severe mitral regurgitation in a single institution. The first 113 patients (Group 1) were operated between March 2012 and September 2015 and the last 113 patients (Group 2) between October 2015 and October 2019. Conventional techniques employed in open surgery were used. Clinical and echographic follow-up were 96.0% and 94.2% complete, respectively. RESULTS Successful mitral repair was achieved in all cases with no hospital mortality. The overall survival rate was 92.7 ± 2.8% and 91.0 ± 3.2% at 3 and 7 years, respectively, with no in between groups difference (p = 0.513). The overall freedom from mitral reoperation was 97.4 ± 1.2% at 3 and 7 years and was similar in both groups (p = 0.276). Freedom from mitral regurgitation Grade 2+ at 3 and 7 years were 89.1 ± 2.6% and 87.9 ± 2.8%, respectively, with no significant difference between groups (p = 0.056). CONCLUSIONS Developing a robotic mitral repair program can be done without compromising the safety and efficacy of repair. After a well-conducted training, robotic approach allows to perform simple and complex mitral repair using similar techniques as in conventional approach and without additional risk for the patient.
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Affiliation(s)
- Maureen Klepper
- Cardiovascular Research Center, Institute for Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Department of Cardiovascular and Thoracic Surgery, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium
| | - Philippe Noirhomme
- Cardiovascular Research Center, Institute for Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Department of Cardiovascular and Thoracic Surgery, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium
| | - Laurent de Kerchove
- Cardiovascular Research Center, Institute for Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Department of Cardiovascular and Thoracic Surgery, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium
| | - Stefano Mastrobuoni
- Cardiovascular Research Center, Institute for Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Department of Cardiovascular and Thoracic Surgery, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium
| | - Cristiano Spadaccio
- Department of Cardiovascular and Thoracic Surgery, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium.,Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Guillaume Lemaire
- Department of Anesthesiology, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium
| | - Gébrine El Khoury
- Cardiovascular Research Center, Institute for Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Department of Cardiovascular and Thoracic Surgery, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium
| | - Emiliano Navarra
- Cardiovascular Research Center, Institute for Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium.,Department of Cardiovascular and Thoracic Surgery, Saint-Luc University Clinics, Catholic University of Louvain, Brussels, Belgium
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5
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Starting A New Robotic Surgery Program for Mitral Valve Repair. Lessons Learned from The First Nine Months. J Clin Med 2021; 10:jcm10225439. [PMID: 34830720 PMCID: PMC8674761 DOI: 10.3390/jcm10225439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Although transcatheter technology is rapidly growing and represents a promising strategy, the surgical approach remains the best way to repair a degenerative mitral valve regurgitation. In this context, robotic surgery is technologically the most advanced method of minimally invasive mitral valve repair. The aim of this study is to present the preliminary results of the initial single-center experience with a new robotic mitral valve repair program. (2) Methods: We retrospectively reviewed the records of patients who underwent robotic mitral valve repair at our Institution between January and September 2021. (3) Results: A total of 29 patients underwent mitral valve repair with annuloplasty and chordal implantation to treat degenerative mitral regurgitation. The procedure's success was achieved in 97% of patients. The 30-day cardiac-related mortality was 0%. The median CPB and cross-clamp times were 189 and 111 min, respectively, with a progressive reduction from the beginning of the robotic program. (4) Conclusions: Considering all the limitations related to the small sample, the presented results of robotic mitral valve repair appear to be encouraging and acceptable. A careful patient selection, a dedicated team, and a robust experience in surgical mitral valve repair are the fundamentals to start a new robotic mitral surgery program.
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Abstract
In most patients, minimally invasive approaches to mitral valve surgery are technically possible. However, in practice, patient selection is critical to mitigate safety concerns when performing the procedure. In this article, we describe our approach to preoperative assessment for minimally invasive mitral valve surgery candidacy, as well as discussing the technical aspects of procedure execution.
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Affiliation(s)
- Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue / J4-1, Cleveland, OH 44195, USA.
| | - Per Wierup
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue / J4-1, Cleveland, OH 44195, USA
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue / J4-1, Cleveland, OH 44195, USA
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7
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Barac YD, Loungani RS, Sabulsky R, Carr K, Zwischenberger B, Glower DD. Sustained results of robotic mitral repair in a lower volume center with extensive minimally invasive mitral repair experience. J Robot Surg 2021; 16:199-206. [PMID: 33761097 DOI: 10.1007/s11701-021-01214-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
The literature for robotic mitral repair is dominated by a small number of large volume institutions, and intermediate-term outcomes out to 5 years are rare. Whether and under what circumstances a lower volume institution could obtain durable outcomes is not known. A retrospective review was performed on all 133 patients undergoing robotically assisted mitral repair from 2011 to 2019 at a single institution. Mean volume of robotic mitral repair was 16 ± 7 cases per year, while mean institutional total volume of mitral repair was 116 ± 16 cases per year. Mean age was 58 ± 12 years, 77% were men, and mitral etiology was prolapse in 90%. Comorbidity was infrequent with atrial fibrillation in 20% and moderate tricuspid regurgitation in 14%. Central aortic cannulation was used in 97% with concurrent tricuspid operation in 5% and concurrent maze in 14%. Median clamp time, pump time, and length of stay were 146 min, 265 min, and 5 days, respectively, but none improved with experience. There were no deaths or stroke. At 5 years, the cumulative incidence of moderate mitral regurgitation was 18 ± 6% (prolapse patients 11 ± 5%), severe regurgitation 4 ± 3%, and mitral replacement 9 ± 5% (prolapse patients 5 ± 3%). 5-year survival was 96 ± 3%. At centers with significant mitral repair volume, a volume of 16 robotic mitral cases/year can yield good clinical outcomes durable out to 5 years. A case volume of 16 cases per year was not sufficient to improve pump time or length of stay over time.
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Affiliation(s)
- Yaron D Barac
- The Sackler Faculty of Medicine, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Rahul S Loungani
- Duke University Medical Center, Box 3851, Durham, NC, 27710, USA
| | - Richard Sabulsky
- Duke University Medical Center, Box 3851, Durham, NC, 27710, USA
| | - Keith Carr
- Duke University Medical Center, Box 3851, Durham, NC, 27710, USA
| | | | - Donald D Glower
- Duke University Medical Center, Box 3851, Durham, NC, 27710, USA.
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8
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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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9
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Toolan C, Palmer K, Al-Rawi O, Ridgway T, Modi P. Robotic mitral valve surgery: a review and tips for safely negotiating the learning curve. J Thorac Dis 2021; 13:1971-1981. [PMID: 33841983 PMCID: PMC8024858 DOI: 10.21037/jtd-20-1790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Totally endoscopic robotic mitral valve repair represents the least invasive surgical therapy for mitral valve disease. Comparative results for robotic mitral valve surgery against sternotomy are impressive, repeatedly demonstrating shorter hospital stay, faster return to normal activities, less morbidity and equivalent mortality and mid-term durability. We lack data comparing robotic approaches to totally endoscopic minimally invasive mitral valve surgery using 3D vision platforms. In this review, we explore the advantages and disadvantages of robotic mitral valve surgery and share technical tips that we have learned to help teams embarking on their robotic journey. We consider factors necessary for the successful implementation of a robotic programme including the importance of training a dedicated team, with the common goal to avoid any compromise in either patient safety or repair quality during the learning curve. As experience grows with robotic techniques and more cardiac surgeons become proficient with this innovative technology, the volume of robotic cardiac procedures around the world will increase helped by the introduction of new robotic systems and patient demand. Well informed patients will increasingly seek out the opportunity of robotic valve reconstruction in reference centres in the hands of a few highly experienced robotic surgeons.
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Affiliation(s)
| | | | - Omar Al-Rawi
- The Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Tim Ridgway
- The Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Paul Modi
- The Liverpool Heart & Chest Hospital, Liverpool, UK
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10
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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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11
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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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12
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Vervoort D, Nguyen DH, Nguyen TC. When Culture Dictates Practice: Adoption of Minimally Invasive Mitral Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:406-409. [DOI: 10.1177/1556984520948644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, MD, USA
| | - Dinh Hoang Nguyen
- Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Tom C. Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, TX, USA
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13
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Soomro NA, Hashimoto DA, Porteous AJ, Ridley CJA, Marsh WJ, Ditto R, Roy S. Systematic review of learning curves in robot-assisted surgery. BJS Open 2019; 4:27-44. [PMID: 32011823 PMCID: PMC6996634 DOI: 10.1002/bjs5.50235] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background Increased uptake of robotic surgery has led to interest in learning curves for robot‐assisted procedures. Learning curves, however, are often poorly defined. This systematic review was conducted to identify the available evidence investigating surgeon learning curves in robot‐assisted surgery. Methods MEDLINE, Embase and the Cochrane Library were searched in February 2018, in accordance with PRISMA guidelines, alongside hand searches of key congresses and existing reviews. Eligible articles were those assessing learning curves associated with robot‐assisted surgery in patients. Results Searches identified 2316 records, of which 68 met the eligibility criteria, reporting on 68 unique studies. Of these, 49 assessed learning curves based on patient data across ten surgical specialties. All 49 were observational, largely single‐arm (35 of 49, 71 per cent) and included few surgeons. Learning curves exhibited substantial heterogeneity, varying between procedures, studies and metrics. Standards of reporting were generally poor, with only 17 of 49 (35 per cent) quantifying previous experience. Methods used to assess the learning curve were heterogeneous, often lacking statistical validation and using ambiguous terminology. Conclusion Learning curve estimates were subject to considerable uncertainty. Robust evidence was lacking, owing to limitations in study design, frequent reporting gaps and substantial heterogeneity in the methods used to assess learning curves. The opportunity remains for the establishment of optimal quantitative methods for the assessment of learning curves, to inform surgical training programmes and improve patient outcomes.
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Affiliation(s)
- N A Soomro
- Newcastle Upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - D A Hashimoto
- Surgical Artificial Intelligence and Innovation Laboratory, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - R Ditto
- Ethicon, Blue Ash, Ohio, USA
| | - S Roy
- Ethicon, Blue Ash, Ohio, USA
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Outcomes and Resource Utilization in Robotic Mitral Valve Repair: Beyond the Learning Curve. J Surg Res 2019; 235:258-263. [DOI: 10.1016/j.jss.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
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15
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Woo YJ, Handy JR, Sade RM. First in line for robotic surgery: Would you want to know? J Thorac Cardiovasc Surg 2018; 157:1934-1940. [PMID: 30578065 DOI: 10.1016/j.jtcvs.2018.11.025] [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: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | | | - Robert M Sade
- Department of Surgery and Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, SC.
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Abstract
A summary of its uses in mitral valve surgery and coronary artery revascularisation.
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