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Koulaouzidis G, Charisopoulou D, Bomba P, Stachura J, Gasior P, Harpula J, Zarifis J, Marlicz W, Hudziak D, Jadczyk T. Robotic-Assisted Solutions for Invasive Cardiology, Cardiac Surgery and Routine On-Ward Tasks: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:399. [PMID: 37754828 PMCID: PMC10532157 DOI: 10.3390/jcdd10090399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive cardiac electrophysiology procedures as well as surgical operations including minimally invasive aortic and mitral valve repair, coronary artery bypass procedures, and structural heart diseases. Furthermore, machines are used as staff-assisting tools to support nurses with repetitive clinical duties i.e., food delivery. High precision and resolution allow for excellent maneuverability, enabling the performance of medical procedures in challenging anatomies that are difficult or impossible using conventional approaches. Moreover, robot-assisted techniques protect operators from occupational hazards, reducing exposure to ionizing radiation, and limiting risk of orthopedic injuries. Novel automatic systems provide advantages for patients, ensuring device stability with optimized utilization of fluoroscopy. The acceptance of robotic technology among healthcare providers as well as patients paves the way for widespread clinical application in the field of cardiovascular medicine. However, incorporation of robotic systems is associated with some disadvantages including high costs of installation and expensive disposable instrumentations, the need for large operating room space, and the necessity of dedicated training for operators due to the challenging learning curve of robotic-assisted interventional systems.
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Affiliation(s)
- George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Dafni Charisopoulou
- Pediatric Cardiology Department, Great Ormond Street Hospital, London WC1N 3JH, UK;
| | | | | | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - Jan Harpula
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - John Zarifis
- Cardiology Department, George Papanikolaou General Hospital, 570 10 Thessaloniki, Greece;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 71-455 Szczecin, Poland;
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland;
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, 602 00 Brno, Czech Republic
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2
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Hardman G, Zacharias J. Minimal-Access Atrial Septal Defect (ASD) Closure. J Cardiovasc Dev Dis 2023; 10:jcdd10050206. [PMID: 37233173 DOI: 10.3390/jcdd10050206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 05/27/2023] Open
Abstract
Progress towards the development and adoption of minimally invasive techniques in cardiac surgery has been slower than that seen in other surgical specialties. Congenital heart disease (CHD) patients represent an important population within cardiac disease, of which atrial septal defect (ASD) is one of the most common diagnoses. Management of ASD encompasses a range of minimal-access and minimally invasive approaches, including transcatheter device closure, mini-sternotomy, thoracotomy, video-assisted, endoscopic, and robotic approaches. In this article, we will discuss the pathophysiology of ASD, along with diagnosis, management, and indications for intervention. We will review the current evidence supporting minimally invasive and minimal-access surgical ASD closure in the adult and paediatric patient, highlighting peri-operative considerations and areas for further research.
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Affiliation(s)
- Gillian Hardman
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
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Mehta A, Cheng Ng J, Andrew Awuah W, Huang H, Kalmanovich J, Agrawal A, Abdul-Rahman T, Hasan MM, Sikora V, Isik A. Embracing robotic surgery in low- and middle-income countries: Potential benefits, challenges, and scope in the future. Ann Med Surg (Lond) 2022; 84:104803. [PMID: 36582867 PMCID: PMC9793116 DOI: 10.1016/j.amsu.2022.104803] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2022] Open
Abstract
Robotic surgery has applications in many medical specialties, including urology, general surgery, and surgical oncology. In the context of a widespread resource and personnel shortage in Low- and Middle-Income Countries (LMICs), the use of robotics in surgery may help to reduce physician burnout, surgical site infections, and hospital stays. However, a lack of haptic feedback and potential socioeconomic factors such as high implementation costs and a lack of trained personnel may limit its accessibility and application. Specific improvements focused on improved financial and technical support to LMICs can help improve access and have the potential to transform the surgical experience for both surgeons and patients in LMICs. This review focuses on the evolution of robotic surgery, with an emphasis on challenges and recommendations to facilitate wider implementation and improved patient outcomes.
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Affiliation(s)
- Aashna Mehta
- University of Debrecen-Faculty of Medicine, Debrecen, 4032, Hungary
| | - Jyi Cheng Ng
- Faculty of Medicine and Health Sciences, University of Putra Malaysia, Serdang, Malaysia
| | | | - Helen Huang
- Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
| | | | - Aniket Agrawal
- Department of Pediatric Surgery, Center for Children, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh,Corresponding author.
| | - Vladyslav Sikora
- Sumy State University and Toufik's World Medical Association, Sumy, Ukraine
| | - Arda Isik
- Istanbul Medeniyet University, Department of General Surgery, Istanbul, Turkey
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4
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Wang J, Xie W, Cheng M, Wu Q, Wang F, Li P, Fan B, Zhang X, Wang B, Liu X. Assessment of Transcatheter or Surgical Closure of Atrial Septal Defect using Interpretable Deep Keypoint Stadiometry. RESEARCH (WASHINGTON, D.C.) 2022; 2022:9790653. [PMID: 36340508 PMCID: PMC9620637 DOI: 10.34133/2022/9790653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/03/2022] [Indexed: 12/01/2023]
Abstract
Automated echocardiogram interpretation with artificial intelligence (AI) has the potential to facilitate the serial diagnosis of heart defects by primary clinician. However, the fully automated and interpretable analysis pipeline for suggesting a treatment plan is largely underexplored. The present study targets to build an automatic and interpretable assistant for the transthoracic echocardiogram- (TTE-) based assessment of atrial septal defect (ASD) with deep learning (DL). We developed a novel deep keypoint stadiometry (DKS) model, which learns to precisely localize the keypoints, i.e., the endpoints of defects and followed by the absolute distance measurement with the scale. The closure plan and the size of the ASD occluder for transcatheter closure are derived based on the explicit clinical decision rules. A total of 3,474 2D and Doppler TTE from 579 patients were retrospectively collected from two clinical groups. The accuracy of closure classification using DKS (0.9425 ± 0.0052) outperforms the "black-box" model (0.7646 ± 0.0068; p < 0.0001) for within-center evaluation. The results in cross-center cases or using the quadratic weighted kappa as an evaluation metric are consistent. The fine-grained keypoint label provides more explicit supervision for network training. While DKS can be fully automated, clinicians can intervene and edit at different steps of the process as well. Our deep learning keypoint localization can provide an automatic and transparent way for assessing size-sensitive congenital heart defects, which has huge potential value for application in primary medical institutions in China. Also, more size-sensitive treatment planning tasks may be explored in the future.
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Affiliation(s)
- Jing Wang
- School of Basic Medical Sciences, Capital Medical University, Beijing 10069, China
| | - Wanqing Xie
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei 230032, China
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA 02215, USA
| | - Mingmei Cheng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei 230032, China
| | - Qun Wu
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Fangyun Wang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Pei Li
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Bo Fan
- School of Basic Medical Sciences, Capital Medical University, Beijing 10069, China
| | - Xin Zhang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Binbin Wang
- Center for Genetics, National Research Institute for Family Planning, Beijing 100730, China
- Graduated school, Peking Union Medical College, Beijing 100730, China
| | - Xiaofeng Liu
- Gordon Center for Medical Imaging, Harvard Medical School, and Massachusetts General Hospital, Boston, MA 02114, USA
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Total Thoracoscopic versus Robotic Surgery for Repair of Atrial Septum Defect: A Propensity Matching Score Analysis. Emerg Med Int 2022; 2022:5371493. [PMID: 36193543 PMCID: PMC9525788 DOI: 10.1155/2022/5371493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 12/07/2022] Open
Abstract
Robotic surgery can provide less surgical trauma than conventional surgery, but differences between robotic and thoracoscopic surgery for atrial septal defect (ASD) repair are not well documented. To explore whether ASD can be repaired by thoracoscopic surgery or robotic surgery, which procedure is less invasive, and the difference in outcomes between these two procedures, this article studies 160 patients undergoing ASD repair at our institution. Sixty-five patients underwent total thoracoscopic surgery and 95 patients underwent total endoscopic robotic surgery. Propensity score matching yielded 64 well-matched patient pairs. Surgical data and early postoperative outcomes between the two matched groups were analyzed and compared. The results show that thoracoscopic and robotic surgery to repair ASD are both safe and reliable, and the early curative effect is good. However, regardless of similar complication rates, robotic surgery has a shorter time, less postoperative drainage, and faster recovery than thoracoscopic surgery.
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Cerny S, Oosterlinck W, Onan B, Singh S, Segers P, Bolcal C, Alhan C, Navarra E, Pettinari M, Van Praet F, De Praetere H, Vojacek J, Cebotaru T, Modi P, Doguet F, Franke U, Ouda A, Melly L, Malapert G, Labrousse L, Gianoli M, Agnino A, Philipsen T, Jansens JL, Folliguet T, Palmen M, Pereda D, Musumeci F, Suwalski P, Cathenis K, Van den Eynde J, Bonatti J. Robotic Cardiac Surgery in Europe: Status 2020. Front Cardiovasc Med 2022; 8:827515. [PMID: 35127877 PMCID: PMC8811127 DOI: 10.3389/fcvm.2021.827515] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background European surgeons were the first worldwide to use robotic techniques in cardiac surgery and major steps in procedure development were taken in Europe. After a hype in the early 2000s case numbers decreased but due to technological improvements renewed interest can be noted. We assessed the current activities and outcomes in robotically assisted cardiac surgery on the European continent. Methods Data were collected in an international anonymized registry of 26 European centers with a robotic cardiac surgery program. Results During a 4-year period (2016–2019), 2,563 procedures were carried out [30.0% female, 58.5 (15.4) years old, EuroSCORE II 1.56 (1.74)], including robotically assisted coronary bypass grafting (n = 1266, 49.4%), robotic mitral or tricuspid valve surgery (n = 945, 36.9%), isolated atrial septal defect closure (n = 225, 8.8%), left atrial myxoma resection (n = 54, 2.1%), and other procedures (n = 73, 2.8%). The number of procedures doubled during the study period (from n = 435 in 2016 to n = 923 in 2019). The mean cardiopulmonary bypass time in pump assisted cases was 148.6 (63.5) min and the myocardial ischemic time was 88.7 (46.1) min. Conversion to larger thoracic incisions was required in 56 cases (2.2%). Perioperative rates of revision for bleeding, stroke, and mortality were 56 (2.2%), 6 (0.2 %), and 27 (1.1%), respectively. Median postoperative hospital length of stay was 6.6 (6.6) days. Conclusion Robotic cardiac surgery case numbers in Europe are growing fast, including a large spectrum of procedures. Conversion rates are low and clinical outcomes are favorable, indicating safe conduct of these high-tech minimally invasive procedures.
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Affiliation(s)
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- *Correspondence: Wouter Oosterlinck
| | - Burak Onan
- Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Patrique Segers
- Maastricht University Medical Center, Maastricht, Netherlands
| | - Cengiz Bolcal
- Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | | | | | | | | | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czechia
| | | | - Paul Modi
- Liverpool Heart and Chest, Liverpool, United Kingdom
| | | | | | - Ahmed Ouda
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | - Thierry Folliguet
- Henri MONDOR Hospital, Assitance Publique/Hopitaux de Paris, Paris, France
| | | | | | | | - Piotr Suwalski
- Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Jef Van den Eynde
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
- Jef Van den Eynde
| | - Johannes Bonatti
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
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Transcatheter versus surgical closure of atrial septal defects: a systematic review and meta-analysis of clinical outcomes. Cardiol Young 2022; 32:1-9. [PMID: 34819196 DOI: 10.1017/s1047951121004583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Atrial septal defects are a common form of CHD and dependent on the size and nature of atrial septal defects, closure may be warranted. The paper aims to compare outcomes of transcatheter versus surgical repair of atrial septal defects. METHODS A comprehensive electronic literature search was conducted. Primary studies were included if they compared both closure techniques. Primary outcomes included procedural success, mortality, and reintervention rate. Secondary outcomes included residual defect and mean hospital stay. RESULTS A total of 33 studies were included in meta-analysis. Mean total hospital stay was significantly shorter in the transcatheter cohort across both the adult (95% confidence interval, mean difference -4.05 (-4.78, -3.32) p < 0.00001) and paediatric populations (95% confidence interval, mean difference -4.78 (-5.97, -3.60) p < 0.00001). There were significantly fewer complications in the transcatheter group across both the adult (odds ratio 0.45, 95% confidence interval, [0.28, 0.72], p < 0.00001) and paediatric cohorts (odds ratio 0.26, 95% confidence interval, [0.14, 0.49], p < 0.00001). No significant difference in overall mortality was found between transcatheter versus surgical closure across the two groups, adult (odds ratio 0.76, 95% confidence interval, [0.40, 1.45], p = 0.41), paediatrics (odds ratio 0.62, 95% confidence interval, [0.21, 1.83], p = 0.39). CONCLUSION Both transcatheter and surgical approaches are safe and effective techniques for atrial septal defect closure. Our study has demonstrated the benefits of transcatheter closure in terms of lower complication rates and mean hospital stay. However, surgery still has a place for more complex closure and, as we have demonstrated, shows no difference in mortality.
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Himelfarb JD, Shulman H, Olesovsky CJ, Rumman RK, Oliva L, Friedland J, Farrell A, Huszti E, Horlick E, Abrahamyan L. Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis. Heart 2021; 108:1216-1224. [PMID: 34675040 DOI: 10.1136/heartjnl-2021-319794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development. METHODS Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model. RESULTS A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I2=83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I2=0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I2=55%) compared with a rate of 1.19 per 100 person-years (I2=85%) for studies with follow-up duration >2 years. CONCLUSIONS The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl.
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Affiliation(s)
| | - Healey Shulman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Rawan K Rumman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Oliva
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Joshua Friedland
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Farrell
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Biostatistics Research Unit, University Health Network, Toronto, Ontario
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Big data and new information technology: what cardiologists need to know. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:81-89. [PMID: 33008773 DOI: 10.1016/j.rec.2020.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022]
Abstract
Technological progress in medicine is constantly garnering pace, requiring that physicians constantly update their knowledge. The new wave of technologies breaking through into clinical practice includes the following: a) mHealth, which allows constant monitoring of biological parameters, anytime, anyplace, of hundreds of patients at the same time; b) artificial intelligence, which, powered by new deep learning techniques, are starting to beat human experts at their own game: diagnosis by imaging or electrocardiography; c) 3-dimensional printing, which may lead to patient-specific prostheses; d) systems medicine, which has arisen from big data, and which will open the way to personalized medicine by bringing together genetic, epigenetic, environmental, clinical and social data into complex integral mathematical models to design highly personalized therapies. This state-of-the-art review aims to summarize in a single document the most recent and most important technological trends that are being applied to cardiology, and to provide an overall view that will allow readers to discern at a glance the direction of cardiology in the next few years.
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Baladrón C, Gómez de Diego JJ, Amat-Santos IJ. Big data y nuevas tecnologías de la información: qué necesita saber el cardiólogo. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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He C, Zhou Y, Tang SS, Luo LH, Feng K. Completed atrioventricular block induced by atrial septal defect occluder unfolding: A case report. World J Clin Cases 2020; 8:5715-5721. [PMID: 33344565 PMCID: PMC7716307 DOI: 10.12998/wjcc.v8.i22.5715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An atrial septal defect is a common condition and accounts for 25% of adult congenital heart diseases. Transcatheter occlusion is a widely used technique for the treatment of secondary aperture-type atrial septal defects (ASDs).
CASE SUMMARY A 30-year-old female patient was diagnosed with ASD by transthoracic echocardiography (TTE) 1 year ago. The electrocardiogram showed a heart rate of 88 beats per minute, normal sinus rhythm, and no change in the ST-T wave. After admission, TTE showed an atrial septal defect with a left-to-right shunt, aortic root short-axis section with an ASD diameter of 8 mm, a parasternal four-chamber section with an ASD diameter of 9 mm, and subxiphoid biatrial section with a diameter of 13 mm. Percutaneous occlusion was proposed. The intraoperative TTE scan showed that the atrial septal defect was oval in shape, was located near the root of the aorta, and had a maximum diameter of 13 mm. A 10-F sheath was placed in the right femoral vein, and a 0.035° hard guidewire was used to establish the transport track between the left pulmonary vein and the inferior vena cava. A shape-memory alloy atrial septal occluder with a waist diameter of 20 mm was placed successfully and located correctly. TTE showed that the double disk unfolded well and that the clamping of the atrial septum was smooth. Immediately after the disc was revealed, electrocardiograph monitoring showed that the ST interval of the inferior leads was prolonged, the P waves and QRS waves were separated, a junctional escape rhythm maintained the heart rate, and the blood pressure began to decrease. After removing the occluder, the elevation in the ST segment returned to normal immediately, and the sinus rhythm returned to average approximately 10 min later. After consulting the patient’s family, we finally decided to withdraw from the operation.
CONCLUSION Compression of the small coronary artery, which provides an alternative blood supply to the atrioventricular nodule during the operation, leads to the emergence of a complete atrioventricular block.
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Affiliation(s)
- Chuan He
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Yang Zhou
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Si-Si Tang
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Li-Hong Luo
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Kun Feng
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
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Onan B, Onan IS. Early Results of Robotically Assisted Congenital Cardiac Surgery: Analysis of 242 Patients. Ann Thorac Surg 2020; 112:2020-2027. [DOI: 10.1016/j.athoracsur.2020.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/26/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022]
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13
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Güllü AÜ, Şenay Ş, Ersin E, Demirhisar Ö, Kocyigit M, Alhan C. Feasibility of robotic-assisted atrial septal defect repair in a 6-year-old patient. Int J Med Robot 2020; 17:e2185. [PMID: 33085979 DOI: 10.1002/rcs.2185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/07/2020] [Accepted: 10/16/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The feasibility, safety and advantages of minimally invasive or robotic repair of atrial septal defect (ASD) in adults were reported previously. However, there is limited data for the application of these systems in paediatric patients. Although current robotic systems still have large instruments for surgical repair in children, some appropriate patients may benefit from this technology. METHOD A 6-year-old child with ASD underwent robotic assistant repair via Da-Vinci Robotic Systems. Venous cannulation was achieved by internal jugular and femoral veins (10F-14F) and arterial cannulation was performed via femoral artery under transesophageal echocardiography (TEE) guidance (10F). A 3 cm incision was made in the right fourth intercostal space, used for working and the camera port in the same time. The ports were placed considering not to damage the potential developing breast tissue. After the port implantation (8F) and cardiac arrest, the ASD repair was completed with primary closure technique. RESULT The perioperative period was uneventful and the patient was discharged from hospital 5 days after surgery. CONCLUSION ASD closure with robotic assistant was achieved in a large enough sized paediatric patient. With the development of thinner and shorter robotic arms, it will be possible to use robotic assistance more common during the repair of congenital heart diseases.
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Affiliation(s)
- Ahmet Ümit Güllü
- Department of Cardiovascular Surgery, Acıbadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Şahin Şenay
- Department of Cardiovascular Surgery, Acıbadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Egemen Ersin
- Programme of Perfusion, Acıbadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Önder Demirhisar
- Programme of Perfusion, Acıbadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Muharrem Kocyigit
- Department of Anesthesiology, Acıbadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acıbadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
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Minimal access in cardiac surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:708-724. [PMID: 33403151 PMCID: PMC7759047 DOI: 10.5606/tgkdc.dergisi.2020.19614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/01/2020] [Indexed: 11/21/2022]
Abstract
Over the past two decades, minimally invasive cardiac surgery has been adopted with the use of endoscopic methods in 1990s and advanced robotic surgery since the early 2000s. In parallel with technological developments, surgical experience has increased and several cardiac operations are able to be performed using different mini-incisions. In this review, we discuss approaches to minimally invasive cardiac surgery, incisions, technical details, and suggestions.
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Guler S, Reyhancan A, Kubat E, Onan IS, Kadirogullari E, Onan B. Impact of additional annuloplasty on tricuspid valve and cardiac functions after atrial septal defect closure in adults. J Card Surg 2020; 35:2895-2901. [PMID: 32743865 DOI: 10.1111/jocs.14905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical indications for moderate to severe tricuspid regurgitation (TR) during atrial septal defect (ASD) closure are still unclear. Additional tricuspid valve annuloplasty (TVP) can be beneficial to avoid postoperative persistent TR. Therefore, we compared the results of surgical ASD closure with or without additional TVP in patients who presented with moderate-to-severe TR. METHODS Between November 2009 and June 2016, 103 patients with ASD and moderate-to-severe TR underwent surgical ASD closure without (n = 76, group 1) and with additional TVP (n = 27, group 2). Clinical outcomes and echocardiographic data were analyzed. RESULTS There was no mortality. Postoperative outcomes were similar despite significantly longer aortic clamping time in group 2 (P = .003). Mean TR grade, right atrial diameter, right ventricular end-diastolic diameter, pulmonary artery pressure, and Qp/Qs ratio decreased significantly in both groups (P < .05). Mean follow-up time was 5.3 months (range: 1 month-6.2 years) in group 1 and 6.1 months (range: 1 month-4.1 years) in group 2 (P = .66). Echocardiography results showed significant decrease in TR grade in both groups (P = .93). The incidence of persistent moderate to severe TR was higher in isolated ASD closure group (14.4% vs 3.7%, P = .086). Additional TVP provided greater regression in TR grade (-1.49 ± 0.9 vs -1.89 ± 0.8, P = .041). CONCLUSION Despite TVP being associated with longer ischemic time, postoperative outcomes were comparable to ASD closure alone. Both approach demonstrated an effective decrease in TR, but TVP provided greater regression and lower incidence of persistent TR. Therefore, additional TVP should be considered in patients undergoing ASD closure with moderate-to-severe TR.
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Affiliation(s)
- Salih Guler
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Adem Reyhancan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Emre Kubat
- Department of Cardiovascular Surgery, Gulhane Training and Research Surgery Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ismihan Selen Onan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Ersin Kadirogullari
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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A comparison of robotically-assisted endoscopic versus sternotomy approach for myxoma excision: A single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:450-459. [PMID: 32953207 DOI: 10.5606/tgkdc.dergisi.2020.19278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/05/2020] [Indexed: 11/21/2022]
Abstract
Background In this study, we present our single-center experience in robotically-assisted endoscopic surgery versus conventional median sternotomy approach in patients undergoing cardiac myxoma excision. Methods Between January 2011 and September 2019, a total of 46 patients (24 males, 22 females; mean age 54.1±12.5 years; range, 25 to 79 years) who had a confirmed diagnosis of isolated cardiac myxoma were included in the study. The patients were divided into two groups as those undergoing robotic-assisted surgery (n=16) and those undergoing conventional median sternotomy (n=30). Clinical characteristics, operative, and postoperative outcomes were compared. Robotic approach to right or left-sided tumors and postoperative pain scores were also analyzed. Results There was no mortality or major complication. No conversion to sternotomy was needed in robotic procedures. The mean cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the median sternotomy group (p=0.001 for both). The mean ventilation time and the length of hospital stay were significantly shorter in robotic surgery than sternotomy group (p=0.043 and p=0.048, respectively). The mean amount of postoperative blood loss and transfusion rate were significantly lower in robotic surgery patients (p=0.001 and p=0.022, respectively). The mean postoperative pain scores were significantly lower in patients undergoing robotic surgery (p=0.022). Conclusion Robotic-assisted endoscopic surgery can be performed safely and effectively for cardiac myxoma excision with shorter hospital stay, less pain, and less amount of blood product use, as well as more favorable cosmetic results compared to conventional median sternotomy.
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Sen O, Onan B, Aydin U, Kadirogullari E, Kahraman Z, Basgoze S. Robotic-assisted cardiac surgery without lung isolation utilizing single-lumen endotracheal tube intubation. J Card Surg 2020; 35:1267-1274. [PMID: 32353922 DOI: 10.1111/jocs.14575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study assessed the feasibility and outcomes of performing robotic cardiac surgery without lung isolation using single-lumen (SL) endotracheal tube intubation. METHODS Between 2013 and 2017, 132 patients underwent robotically-assisted atrial septal defect closure. A retrospective analysis was performed of 23 patients (11 males, mean age 30.9 ± 5 years) who underwent robotic surgery with double-lumen (DL) endotracheal tube intubation (group 1) compared with 109 patients (57 males, mean age 32.4 ± 7.5 years) undergoing the same procedure with SL endotracheal intubation (group 2). The patient groups were compared in terms of demographic characteristics, operative data, and complications. The technical feasibility of the robotic procedure without lung isolation was evaluated. RESULTS There were no mortality, intraoperative complication, and conversion. Mean total anesthesia time was significantly decreased in the SL intubation group (238.3 ± 22.4 vs 227.2 ± 21.2 minutes; P = .025). First-pass intubation success was significantly higher in the SL intubation group (17 [73.9%] vs 98 [89.9%] patients; P = .032). Mean ventilation time (10.9 ± 5.3 hours), intensive care unit stay (16.8 ± 10.1 hours), and the length of hospital stay (3.8 ± 1.2 days) was significantly decreased in patients with SL tube (P < .05). Unilateral reexpansion pulmonary edema was observed in five (21.7%) patients with DL tube, whereas no patient with SL tube had this complication. CONCLUSIONS SL endotracheal tube intubation without lung isolation is a feasible and safe airway alternative in robotic cardiac procedures. This approach resulted in shorter anesthesia time, ventilation time and the length of hospital stay. Port placement and robotic set-up can be uneventfully performed without lung isolation.
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Affiliation(s)
- Onur Sen
- Departments of Cardiovascular Surgery, University of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Burak Onan
- Departments of Cardiovascular Surgery, University of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Unal Aydin
- Departments of Cardiovascular Surgery, University of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Ersin Kadirogullari
- Departments of Cardiovascular Surgery, University of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Zeynep Kahraman
- Department of Anesthesiology and Reanimation, University of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
| | - Serdar Basgoze
- Departments of Cardiovascular Surgery, University of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
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