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Tang S, Qu Y, Jiang H, Cai H, Zhang R, Hong J, Zheng Z, Yang X, Liu J. Minimally invasive technique facilitates early extubation after cardiac surgery: a single-center retrospective study. BMC Anesthesiol 2024; 24:318. [PMID: 39244531 PMCID: PMC11380348 DOI: 10.1186/s12871-024-02710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Postoperative time to extubation plays a role in prognosis after heart valve surgery; however, its exact impact has not been clarified. This study compared the postoperative outcomes of minimally invasive surgery and conventional sternotomy, focusing on early extubation and factors influencing prolonged mechanical ventilation. METHODS Data from 744 patients who underwent heart valve surgery at the Zhejiang Provincial People's Hospital between August 2019 and June 2022 were retrospectively analyzed. The outcomes in patients who underwent conventional median sternotomy (MS) and minimally invasive (MI) video-assisted thoracoscopic surgery were compared using inverse probability of treatment weighting (IPTW) and Kaplan-Meier curves. Clinical data, including surgical data, postoperative cardiac function, postoperative complications, and intensive care monitoring data, were analyzed. RESULTS After propensity score matching and IPTW, 196 cases of conventional MS were compared with 196 cases of MI video-assisted thoracoscopic surgery. Compared to patients in the conventional MS group, those in the MI video-assisted thoracoscopic surgery group in the matched cohort had a higher early postoperative extubation rate (P < 0.01), reduced incidence of postoperative pleural effusion (P < 0.05), significantly shorter length of stay in the intensive care unit (P < 0.01), shorter overall length of hospital stay (P < 0.01), and lower total cost of hospitalization (P < 0.01). CONCLUSIONS Successful early tracheal extubation is important for the intensive care management of patients after heart valve surgery. The advantages of MI video-assisted thoracoscopic surgery over conventional MS include significant reductions in the duration of use of mechanical ventilation support, reduced length of intensive care unit stay, reduced total length of hospitalization, and a favorable patient recovery rate.
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Affiliation(s)
- Siyu Tang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University Hangzhou, Hangzhou, 310053, Zhejiang, China
| | - Yan Qu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University Hangzhou, Hangzhou, 310053, Zhejiang, China
| | - Huan Jiang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University Hangzhou, Hangzhou, 310053, Zhejiang, China
| | - Hanhui Cai
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Run Zhang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Jun Hong
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Zihao Zheng
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Xianghong Yang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China.
| | - Jingquan Liu
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China.
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Liu J, Chen B, Zhang YY, Fang LZ, Xie B, Huang HL, Liu J, Lu C, Gu WD, Chen Z, Ma JX, Yuan HY, Chen JM, Zhuang J, Guo HM. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: a propensity score matched comparative study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:341. [PMID: 31475211 DOI: 10.21037/atm.2019.07.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To compare surgical outcomes after mitral valve replacement via either minimally invasive thoracoscopic (MIs) or traditional median sternotomy (MS) surgery and determine the short- and mid-term clinical outcomes of the MI approach. Methods All patients who received either MIs (n=405) or MS (n=691) mitral valve replacement surgery at the Guangdong Cardiovascular Institute between January 2012 and July 2015 were analyzed for outcome differences due to surgical approach using propensity score matching. The best 202 matches from the MI group and the MS group were analyzed. The clinical data of the two groups were collected, including preoperative cardiac function, operative data, postoperative complications, and follow-up. Results A final total of 404 patients were included in this study after propensity score matching; the MIs group and the MS group each contained 202 patients. The two groups were similar in age, weight, pathological changes, and surgical approach. Compared with the MS group, the MIs group had a longer cardiopulmonary bypass time (P<0.001), aortic cross-clamping time (P<0.001), and total procedure time (P<0.001). There were no significant differences between the groups regarding in-hospital mortality, stroke, pneumonia, acute renal failure, arrhythmia, and chylothorax. The MS group had significantly more patients with poor wound healing than the MIs group (P=0.004). The MI group had a lower rate of transfusion (P=0.037), shorter ventilation time (P=0.041), shorter ICU stay (P=0.033), reduced chest tube drainage and length of chest tube stay (P<0.001), and shorter hospital stay (P<0.001). There was no significant difference between the groups in hospital re-admission for bleeding, but the total hospitalization cost was higher in the MIs group (P=0.002). The mean follow-up was 26.59±12.33 months, the 1-year postoperative survival rate was 98.86%, and the overall survival rate was 97.44%. Compared with the MS group, the MIs group recovered earlier (P<0.05), and returned to work or study earlier (P<0.05). More patients in the MIs group were satisfied with the wound (P<0.001). The MS group had a higher incidence of postoperative osteomyelitis than the MIs group (P=0.028). There were no significant differences between groups in rates of mortality, stroke, pacemaker, reoperation, or 36-item Short Form Health Survey score. Conclusions Compared with the MS approach, the MIs method of mitral valve replacement has longer cardiopulmonary bypass time and aortic cross-clamp time; however, it does not increase the risk of mortality and complications. Furthermore, MIs causes less trauma, fewer transfusions, less wound infection, faster recovery, faster return to work or study, and greater satisfaction with the incision in the mid-term. MI cardiac surgery is safe, effective, and feasible.
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Affiliation(s)
- Jian Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Bo Chen
- Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou 525200, China
| | - Yu-Yuan Zhang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Liang-Zheng Fang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Bin Xie
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Huan-Lei Huang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Jing Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Cong Lu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Wen-Da Gu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Zhao Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Jie-Xu Ma
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Hai-Yun Yuan
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Ji-Mei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
| | - Hui-Ming Guo
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China
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Sun HS, Ma WG, Xu JP, Sun LZ, Lu F, Zhu XD. Minimal Access Heart Surgery via Lower Ministernotomy: Experience in 460 Cases. Asian Cardiovasc Thorac Ann 2016; 14:109-13. [PMID: 16551816 DOI: 10.1177/021849230601400206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minimally invasive cardiac surgery has captured the interest and attention of cardiac surgeons throughout the world. We reviewed our experience of minimal access cardiac operations performed through a lower median ministernotomy. Between January 1997 and August 2003, 100 congenital, 178 valvular, 168 coronary, 12 aneurysmal, and 2 other operations were performed via a 6 to 9 cm lower ministernotomy in 460 consecutive patients. No special instruments were required. Four patients died, and 2 re-operations were necessary. Complications occurred in 28 patients (6.1%). The mean cardiopulmonary bypass time was 88.50 ± 65.16 min, crossclamp time was 55.81 ± 31.89 min, time to extubation was 14.71 ± 29.33 h, and total chest drainage was 7.28 ± 5.07 mL·kg−1. Blood transfusions of 951.42 ± 642.34 mL were needed in 282 patients. Postoperative hospital stay was 11.6 ± 6.0 days. Our experience shows that many types of cardiac operations can be performed through a lower ministernotomy. This technique results in less trauma, quick recovery, and reduces the risk of infection and blood loss. It is a safe and easy procedure that can bring about favorable early outcomes in a wide range of cardiac operations.
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Affiliation(s)
- Han-Song Sun
- Department of Cardiovascular Surgery, Fu Wai Hospital, 167 Northern Lishi Road, Beijing 100037, China.
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Minimally invasive mitral valve surgery: a review of the literature. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ariyaratnam P, Loubani M, Griffin SC. Minimally invasive aortic valve replacement: Comparison of long-term outcomes. Asian Cardiovasc Thorac Ann 2015; 23:814-21. [DOI: 10.1177/0218492315587606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Minimally invasive aortic valve replacement tends to be performed in specialist centers. Little data exists with regard to long-term outcomes of the upper hemi-sternotomy technique. We sought to evaluate the short- and long-term outcomes of this procedure in our institution. Methods Data were collected from our cardiac surgical database. We compared the outcomes of all patients who underwent minimally invasive aortic valve replacement with all who underwent conventional aortic valve replacement between July 1999 and December 2013. Propensity-matching analysis was performed to evaluate hospital outcomes. Results There were 125 patients who underwent minimally invasive aortic valve replacement and 1446 who had conventional surgery. After propensity score matching, there were no differences in postoperative mortality or complications between the 2 groups. The only significant differences were longer bypass (62.69 ± 10.12 vs. 68.94 ± 14.79 min, p = 0.002) and crossclamp times (45.48 ± 8.08 vs. 52.30 ± 16.29 min, p < 0.001) in conventional surgery. Long-term survival after minimally invasive aortic valve replacement at 2, 6, and 10 years was 88% ± 3.0%, 79% ± 4.0%, and 66% ± 6.0%, respectively. Predictors of long-term survival were age, peripheral vascular disease, and low ejection fraction ( p < 0.005). Conclusion Minimally invasive aortic valve replacement has similar hospital outcomes compared to conventional aortic valve replacement. The operation is quicker and does not confer any significant increase in complications or length of hospital stay. The long-term outcomes are favorable and justify its continued use by specialist surgeons in the United Kingdom.
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Affiliation(s)
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Steven C Griffin
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
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Boix-Garibo R, Uzzaman MM, Bapat VN. Review of Minimally Invasive Aortic Valve Surgery. Interv Cardiol 2015; 10:144-148. [PMID: 29588692 DOI: 10.15420/icr.2015.10.03.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Minimally invasive aortic valve surgery (MIAVS) has been developed for the last 20 years. The improvements in techniques have permitted cardiac surgeons to perform aortic valve replacement safely and efficiently with minimally incisions. Patients have become older and have multiple comorbidities and this is expected to grow in number. Less-invasive procedures are known to reduce the number of complications, together with smaller incisions, less pain, less blood loss and reduced length of hospital stay. Selective preoperative planning with computed tomography is key to the pre-investigation stage. Hybrid and staged procedures with interventional cardiologists are part of the armamentarium and may be appealing for the present and near future. Despite the nature of demanding procedures and longer learning curve with increased cardiopulmonary bypass times, the outcomes are comparable with same quality as conventional open surgery. Patient recovery is the ultimate purpose of these approaches.
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Affiliation(s)
- Ricardo Boix-Garibo
- Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Vinayak Nilkanth Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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8
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Fenton JR, Doty JR. Minimally invasive aortic valve replacement surgery through lower half sternotomy. J Thorac Dis 2013; 5 Suppl 6:S658-61. [PMID: 24251024 DOI: 10.3978/j.issn.2072-1439.2013.09.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 11/14/2022]
Abstract
Less invasive approaches to aortic valve surgery frequently rely upon the development of new technology and instrumentation. While not suitable for every patient requiring an aortic valve procedure, these less invasive operations can offer certain clinical benefits and are becoming an important part of the modern cardiothoracic surgeon's skillset. A lower partial sternotomy approach provides excellent visualization of the operative field, efficient execution of the operation and many of the benefits of minimally invasive surgery. Importantly, the lower partial sternotomy requires no new or unusual instruments and presents a familiar view to the surgeon. The technique, therefore, lends itself well to being adapted and utilized quickly with a potentially shorter "learning curve" for maximal surgical flexibility and patient benefit.
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Affiliation(s)
- James R Fenton
- Divisions of Cardiovascular and Thoracic Surgery, University of Utah, Salt Lake City, Utah, USA
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Less invasive versus conventional double-valve surgery: A propensity-matched comparison. J Thorac Cardiovasc Surg 2011; 141:1461-8.e4. [DOI: 10.1016/j.jtcvs.2010.05.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/05/2010] [Accepted: 05/05/2010] [Indexed: 11/22/2022]
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Abstract
Prior to performing a robot-assisted coronary artery bypass grafting procedure, a pre-operative computed tomography scan is used to assess patient candidacy and to identify the location of the target vessel. The surgeon then determines the optimal port locations to ensure proper reach to the target with the robotic instruments, while assuming that the heart does not undergo any significant changes between the pre- and intra-operative stages. However, the peri-operative workflow itself leads to changes in heart position and consequently the intra-operative target vessel location. As such, the pre-operative plan must be adequately updated to adjust the target vessel location to better suit the intraoperative condition. Here we propose a technique to predict the position of the peri-operative target vessel location with approximately 3.5 mm RMS accuracy. We believe this technique will potentially reduce the rate of conversion of robot-assisted procedures to traditional open-chest surgery due to poor planning.
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Linte CA, Moore J, Wedlake C, Peters TM. Evaluation of model-enhanced ultrasound-assisted interventional guidance in a cardiac phantom. IEEE Trans Biomed Eng 2010; 57:2209-18. [PMID: 20515706 DOI: 10.1109/tbme.2010.2050886] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Minimizing invasiveness associated with cardiac procedures has led to limited visual access to the target tissues. To address these limitations, we have developed a visualization environment that integrates interventional ultrasound (US) imaging with preoperative anatomical models and virtual representations of the surgical instruments tracked in real time. In this paper, we present a comprehensive evaluation of our model-enhanced US-guidance environment by simulating clinically relevant interventions in vitro . We have demonstrated that model-enhanced US guidance provides a clinically desired targeting accuracy better than 3-mm rms and maintains this level of accuracy even in the case of image-to-patient misalignments that are often encountered in the clinic. These studies emphasize the benefits of integrating real-time imaging with preoperative data to enhance surgical navigation in the absence of direct vision during minimally invasive cardiac interventions.
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Affiliation(s)
- Cristian A Linte
- Imaging Research Laboratories, Robarts ResearchInstitute, University of Western Ontario, London, ON N6A5K8, Canada.
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Targeting accuracy under model-to-subject misalignments in model-guided cardiac surgery. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2009; 12:361-8. [PMID: 20426008 DOI: 10.1007/978-3-642-04268-3_45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In image-guided interventions, anatomical models of organs are often generated from pre-operative images and further employed in planning and guiding therapeutic procedures. However, the accuracy of these models, along with their registration to the subject are crucial for successful therapy delivery. These factors are amplified when manipulating soft tissue undergoing large deformations, such as the heart. When used in guiding beating-heart procedures, pre-operative models may not be sufficient for guidance and they are often complemented with real-time, intra-operative cardiac imaging. Here we demonstrate via in vitro endocardial "therapy" that ultrasound-enhanced model-guided navigation provides sufficient guidance to preserve a clinically-desired targeting accuracy of under 3 mm independently of the model-to-subject misregistrations. These results emphasize the direct benefit of integrating real-time imaging within intra-operative visualization environments considering that model-to-subject misalignments are often encountered clinically.
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Linte CA, Wiles AD, Moore J, Wedlake C, Peters TM. Surgical accuracy under virtual reality-enhanced ultrasound guidance: an in vitro epicardial dynamic study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2008; 2008:62-65. [PMID: 19162594 DOI: 10.1109/iembs.2008.4649091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In the context of our ongoing objective to reduce morbidity associated with cardiac interventions, minimizing invasiveness has inevitably led to more limited visual access to the target tissues. To ameliorate these challenges, we provide the surgeons with a complex visualization environment that integrates interventional ultrasound imaging augmented with pre-operative anatomical models and virtual surgical instruments within a virtual reality environment. In this paper we present an in vitro study on a cardiac phantom aimed at assessing the feasibility and targeting accuracy of our surgical system in comparison to traditional ultrasound imaging for intra-operative surgical guidance. The 'therapy delivery' was modeled in the context of a blinded procedure, mimicking a closed-chest intervention. Four users navigated a tracked pointer to a target, under guidance provide by either US imaging or virtual reality-enhanced ultrasound. A 2.8 mm RMS targeting error was achieved using our novel surgical system, which is adequate from both a clinical and engineering perspective, under the inherent procedure requirements and limitations of the system.
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Affiliation(s)
- Cristian A Linte
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
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Linte CA, Wierzbicki M, Moore J, Guiraudon G, Jones DL, Peters TM. On Enhancing Planning and Navigation of Beating-Heart Mitral Valve Surgery Using Pre-operative Cardiac Models. ACTA ACUST UNITED AC 2007; 2007:475-8. [DOI: 10.1109/iembs.2007.4352326] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tabata M, Umakanthan R, Khalpey Z, Aranki SF, Couper GS, Cohn LH, Shekar PS. Conversion to full sternotomy during minimal-access cardiac surgery: Reasons and results during a 9.5-year experience. J Thorac Cardiovasc Surg 2007; 134:165-9. [PMID: 17599503 DOI: 10.1016/j.jtcvs.2007.01.077] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 01/14/2007] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE A hemisternotomy approach to minimal-access cardiac surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function. Conversion to a full sternotomy is occasionally required for reasons that remain inadequately reported. METHODS Between January 1996 and June 2005, 907 cardiac surgical patients were planned for an upper hemisternotomy and 528 for a lower hemisternotomy. We retrospectively reviewed 45 patients who required conversion to a full sternotomy. RESULTS Twenty-four (2.6%) of 907 patients required a conversion from upper hemisternotomy because of bleeding (n = 8), ventricular dysfunction (n = 5), refractory ventricular arrhythmia (n = 3), poor exposure (n = 2), and other causes (n = 6). Eight (33.3%) of 24 patients died perioperatively. Of the 883 patients who went on to have an operation through the upper hemisternotomy approach, the mortality was 1.7% (15/883). Twenty-one (4.0%) of 528 patients required conversion from a lower hemisternotomy because of poor exposure (n = 16), bleeding (n = 1), refractory ventricular arrhythmia (n = 3), and a retained venous cannula (n = 1). None of these patients died postoperatively. Of the 507 patients who went on to have an operation through the lower hemisternotomy approach, the mortality was 1.2% (6/507). CONCLUSION Conversion to a full sternotomy occurs infrequently during minimal-access cardiac surgery. Upper hemisternotomy conversions are usually urgent after crossclamp removal and are often associated with serious morbidity and mortality. Conversely, lower hemisternotomy conversions are performed electively in the prebypass period because of poor exposure and are not associated with complications.
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Affiliation(s)
- Minoru Tabata
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass 02446, USA
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McVeigh ER, Guttman MA, Lederman RJ, Li M, Kocaturk O, Hunt T, Kozlov S, Horvath KA. Real-time interactive MRI-guided cardiac surgery: aortic valve replacement using a direct apical approach. Magn Reson Med 2007; 56:958-64. [PMID: 17036300 PMCID: PMC1963465 DOI: 10.1002/mrm.21044] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Minimally invasive cardiac surgery requires arresting and emptying of the heart, which compromises visualization of the surgical field. In this feasibility study a novel surgical procedure is demonstrated in which real-time MRI is used to guide the placement of a prosthetic aortic valve in the beating heart via direct apical access in eight porcine hearts. A clinical stentless bioprosthetic valve affixed to a platinum stent was compressed onto a balloon-tipped catheter. This was fed through a 15-18-mm delivery port inserted into the left ventricular (LV) apex via a minimally invasive subxyphoid incision. Using interactive real-time MRI, the surgeon implanted the prosthetic valve in the correct location at the aortic annulus within 90 s. In four of the animals immediately after implantation, ventricular function, blood flow through the valve, and myocardial perfusion were evaluated with MRI. MRI-guided beating-heart surgery may provide patients with a less morbid and more durable solution to structural heart disease.
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Affiliation(s)
- Elliot R McVeigh
- Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1061, USA.
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Greelish JP, Ailiwadi M, Balaguer JM, Ahmad RM, Zhao DX, Petracek MR, Byrne JG. Combined percutaneous coronary intervention and valve surgery. Curr Opin Cardiol 2006; 21:113-7. [PMID: 16470146 DOI: 10.1097/01.hco.0000210307.87231.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews unique advantages emerging in valvular heart disease as the technology of invasive cardiology and cardiac surgery begin to merge. RECENT FINDINGS Minimally invasive valve surgery is increasing in popularity and has helped to reduce morbidity. In addition, preoperative or intraoperative treatment of coronary artery disease by a percutaneous approach has simplified operations and allowed more liberal use of non-traditional incisions. SUMMARY Percutaneous intervention with drug-eluting stents has provided early evidence for decreased restenosis and improved long-term patency rates. At the same time, cardiac surgery has moved toward less invasive approaches performed in new imaging arenas known as 'hybrid' operating rooms. Combining these technological advances is providing unique solutions to valvular heart disease also requiring revascularization, and will likely become the next horizon for strategies in cardiovascular medicine.
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Affiliation(s)
- James P Greelish
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8815, USA
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Detter C, Boehm DH, Reichenspurner H. Minimally invasive valve surgery: different techniques and approaches. Expert Rev Cardiovasc Ther 2004; 2:239-51. [PMID: 15151472 DOI: 10.1586/14779072.2.2.239] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Less invasive approaches to cardiac surgical procedures are being developed in an effort to decrease patient morbidity and enhance postoperative recovery in comparison with conventional methods. Although full median sternotomy has been the standard surgical approach to the heart for more than 30 years, minimally invasive techniques using limited incisions are rapidly gaining acceptance. Potential advantages of a small skin incision include less trauma and tissue injury, leading to a less painful and quicker overall recovery, as well as shorter hospital stays for patients. Decreasing the size of the skin incision for minimally invasive valve surgery to significantly less than the cardiac size requires specific access to the valve to be repaired or replaced. Thus, various minimally invasive techniques and approaches have been described for aortic and mitral valve surgery. This article will review the different minimally invasive techniques and approaches, as well as early results and outcomes for aortic and mitral valve surgery.
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Affiliation(s)
- Christian Detter
- Department of Cardiovascular Surgery, University Hospital Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
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Donias HW, Karamanoukian HL, D'Ancona G, Hoover EL. Minimally invasive mitral valve surgery: from Port Access to fully robotic-assisted surgery. Angiology 2003; 54:93-101. [PMID: 12593501 DOI: 10.1177/000331970305400112] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Currently, there is a growing interest in minimally invasive cardiac surgery, and despite early criticisms, it has become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results. The interest in performing cardiac valve operations through minimal incisions was stimulated by Port Access technology and has evolved to include robotically assisted video-enhanced valve surgery. Robotic assistance has led to shorter operating times and represents an ideal tool to prepare for fully robotic-assisted cardiac procedures. This report will highlight minimally invasive mitral valve surgery with its evolution from Port Access techniques to fully robotic-assisted surgery. The nuances, strengths, and shortcomings, as well as the potential to enhance the valvular procedure, the promise to reduce hospital stay, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma that wide surgical exposure is essential for such complex intracardiac surgery are discussed.
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Affiliation(s)
- Harry W Donias
- Department of Surgery, State University of New York at Buffalo, USA
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The minimum in invasive valve surgery. Indian J Thorac Cardiovasc Surg 2002. [DOI: 10.1007/s12055-002-0025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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