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Yan W, Wang Y, Wang W, Wang Q, Zheng X, Yang S. Propensity-matched analysis of robotic versus sternotomy approaches for mitral valve replacement. J Robot Surg 2023; 17:2375-2386. [PMID: 37423965 PMCID: PMC10492871 DOI: 10.1007/s11701-023-01665-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
To compare early and medium-term outcomes between robotic and sternotomy approaches for mitral valve replacement (MVR). Clinical data of 1393 cases who underwent MVR between January 2014 and January 2023 were collected and stratified into robotic MVR (n = 186) and conventional sternotomy MVR (n = 1207) groups. The baseline data of the two groups of patients were corrected by the propensity score matching (PSM) method. After matching, the baseline characteristics were not significant different between the two groups (standardized mean difference < 10%). Moreover, the rates of operative mortality (P = 0.663), permanent stroke (P = 0.914), renal failure (P = 0.758), pneumonia (P = 0.722), and reoperation (P = 0.509) were not significantly different. Operation, CPB and cross-clamp time were shorter in the sternotomy group. On the other hand, ICU stay time, post-operative LOS, intraoperative transfusion, and intraoperative blood loss were shorter or less in the robot group. Operation, CPB, and cross-clamp time in robot group were all remarkably improved with experience. Finally, all-cause mortality (P = 0.633), redo mitral valve surgery (P = 0.739), and valve-related complications (P = 0.866) in 5 years of follow-up were not different between the two groups. Robotic MVR is safe, feasible, and reproducible for carefully selected patients with good operative outcomes and medium-term clinical outcomes.
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Affiliation(s)
- Wenlong Yan
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yangyang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wei Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qingjiang Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xin Zheng
- Surgical Operating Room, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Sumin Yang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Ökten EM, Özcan ZS, Arslanhan G, Şenay Ş, Güllü AÜ, Koçyiğit M, Değirmencioğlu A, Alhan C. Robotic-assisted mitral valve surgery without aortic cross-clamping: a safe and feasible technique. Front Cardiovasc Med 2023; 10:1111496. [PMID: 37324626 PMCID: PMC10264847 DOI: 10.3389/fcvm.2023.1111496] [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: 11/29/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background The primary objective of this study was to evaluate the safety and feasibility of robotic-assisted mitral valve surgery without aortic cross-clamping. Methods From January 2010 to September 2022, 28 patients underwent robotic-assisted mitral valve surgery without aortic cross-clamping in our center using DaVinci Robotic Systems. Clinical data during the perioperative period and early outcomes of the patients were recorded. Results Most patients were in New York Heart Association (NYHA) class II and III. Mean age and EuroScore II of the patients were 71.5 ± 13.5 and 8.4 ± 3.7 respectively. The patients underwent either mitral valve replacement (n = 16, 57.1%) or mitral valve repair (n = 12, 42.9%). Concomitant procedures were performed including tricuspid valve repair, tricuspid valve replacement, PFO closure, left atrial appendage ligation, left atrial appendage thrombectomy and cryoablation for atrial fibrillation. Mean CPB times were 140.9 ± 44.6 and mean fibrillatory arrest duration was 76.6 ± 18.4. Mean duration of ICU stay was 32.5 ± 28.8 h and mean duration of hospital stay 9.8 ± 8.3 days. One patient (3.6%) underwent revision due to bleeding. New onset renal failure was observed in one (3.6%) patient and postoperative stroke in one (3.6%) patient. Postoperative early mortality was observed in two (7.1%) patients. Conclusions Robotic-assisted mitral valve surgery without cross-clamping is a safe and feasible technique in high-risk patients undergoing redo mitral surgery with severe adhesions as well as in primary mitral valve cases that are complicated with ascending aortic calcification.
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Affiliation(s)
- Eyüp Murat Ökten
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
| | - Zeynep Sıla Özcan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
| | - Gökhan Arslanhan
- Department of Cardiovascular Surgery, Acıbadem Maslak Hospital, Istanbul, Türkiye
| | - Şahin Şenay
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
| | - Ahmet Ümit Güllü
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
| | - Muharrem Koçyiğit
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
| | - Aleks Değirmencioğlu
- Department of Cardiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
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Husen TF, Kohar K, Angelica R, Saputro BIL. Robotic vs other surgery techniques for mitral valve repair and/or replacement: A systematic review and meta-analysis. Hellenic J Cardiol 2023; 71:16-25. [PMID: 36639122 DOI: 10.1016/j.hjc.2022.12.011] [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: 09/21/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Mitral valve repair or replacement (MVr/R) are procedures that aim to correct mitral regurgitation. The three techniques, namely conventional, minimally invasive, and robotic each present their advantages and setbacks. Previous studies had compared each technique with the other but mostly focused on two techniques. In this systematic review and meta-analysis, we attempt to compare all three techniques, to provide a reference for the clinical selection of the best surgical scheme. METHODS The literature search was performed in databases including PubMed, Scopus, Google Scholar, EBSCOHost, Wiley, ProQuest, and Embase, up to June 1st, 2022. Critical appraisal of studies was performed using Newcastle Ottawa Scale converted by Agency for Healthcare Research and Quality (AHRQ). We used bayesian network meta-analysis and conventional meta-analysis (random effects model) to rank and analyze pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Forest plots of pooled effect estimates comparing each treatment and ranking panel using Surface Under the Cumulative Ranking (SUCRA) were used for the intervention measures. RESULTS A total of 18 studies with 60,331 patients were included in this systematic review and meta-analysis. Hospital stay was significantly lower in the group with robotic procedure compared to the conventional interventions in terms of ICU stay and overall length of stay. The mean difference of length of hospital stay days of the conventional group was 2.27 (1.31-3.30) days and of the minimally invasive -0.364 (-2.31-1.53) days compared to the robotic group. The robotic procedure was associated with longer cross-clamp and cardiopulmonary bypass (CPB) times. Nevertheless, the robotic procedure was associated with lower infection (OR = 0.60 [95% CI 0.50-0.73)] rates and in-hospital mortality compared to conventional techniques (OR=0.53 [95% CI 0.40-0.70)] but not the minimally invasive techniques (OR = 1.74 [95% CI 0.48-6.31]). CONCLUSION Robotic surgery showed more favorable surgical outcomes, including hospital stay, post-operational complications and in-hospital mortality, although it was associated with longer cross-clamp time and CPB time compared to other interventions. However, its high cost is a difficult consideration for its widespread clinical implementation.
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Affiliation(s)
- Theresia Feline Husen
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok City, West Java, 16424, Indonesia.
| | - Kelvin Kohar
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok City, West Java, 16424, Indonesia
| | - Ruth Angelica
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok City, West Java, 16424, Indonesia
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Evaluation of anastomosis quality with intraoperative transit time flowmeter in minimally invasive multi-vessel coronary artery bypass grafting via left anterior mini-thoracotomy. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:56-62. [PMID: 36926151 PMCID: PMC10012990 DOI: 10.5606/tgkdc.dergisi.2023.23744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/10/2023] [Indexed: 03/18/2023]
Abstract
Background In this study, we aimed to describe our intraoperative transit-time flow measurement results as an integral component of the operation and evaluate the graft patency and anastomosis quality in patients who underwent minimally invasive multi-vessel coronary artery bypass grafting via mini-thoracotomy. Methods Between May 2020 and September 2021, a total of 45 consecutive patients (32 males, 13 females; mean age: 51.2±8.6 years; range, 41 to 72 years) who underwent minimally invasive multi-vessel coronary artery bypass grafting via left anterior mini-thoracotomy were retrospectively analyzed. We used the technique of intraoperative transit-time flowmetry in all patients. The patients were operated under cardiopulmonary bypass. A saphenous vein graft was used in all anastomoses, except for the left internal thoracic artery. Results The mean left internal mammary artery flow rate was 36.2±14.1 mL/min, mean flow rate of the diagonal grafts was 48.2±13.1 mL/min, mean flow rate of the circumflex grafts was 41.2±21.1 mL/min, and mean flow rate of the right coronary artery grafts was 52.2±11.3 mL/min. Wave patterns and flow parameters of all grafts were normal in the intraoperative measurements, since the pulsatility index values in all anastomoses were within normal limits. The operation was completed after anastomotic openings and graft patency were ensured. Conclusion The use of an intraoperative flowmeter to show the graft patency and anastomosis quality gives confidence both to the surgeon and the patient. In multi-vessel coronary artery bypass grafting via mini-thoracotomy, anastomosis quality can be evaluated well with this technique.
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Bolcal C, Kadan M, Erol G, Kubat E, Fırtına S, Özdem T, İnce ME, Demirkıran T, Karabacak K, Doğancı S, Yıldırım V. Robotic-assisted beating heart mitral valve surgery: Preliminary report. J Card Surg 2022; 37:4790-4796. [PMID: 36335615 DOI: 10.1111/jocs.17124] [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: 05/22/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Robotic mitral valve surgery is a challenging issue, particularly in patients who are not suitable for aortic cross-clamping. In this study, we aimed to determine the feasibility and benefits of robotic, beating heart mitral valve surgery. METHODS From February 2019 to February 2022, 17 patients underwent robotic beating heart mitral valve surgery. Fourteen of the patients had previous cardiac surgery. The mean age was 58.1 ± 10.3. Dense periaortic adhesions, heavily calcified aorta, and low ejection fraction were retained as indications for beating heart surgery. RESULTS Mitral valve replacement was performed in 14 patients. Mitral ring annuloplasty was performed in two patients with low ejection fraction (EF). A severe paravalvular leak was repaired in one patient. Additional tricuspid annuloplasties were performed in three patients. Cardiopulmonary bypass time were 185.6 ± 55 min. There were no cases of conversion to sternotomy or thoracotomy. No cerebrovascular event occurred in the follow-up. One patient died as a result of secondary hepatorenal syndrome and multiorgan failure. CONCLUSIONS Robotic beating heart mitral valve surgery is a feasible and effective technique with favorable early and mid-term results, especially in patients who are not suitable for aortic cross-clamping, secondary to periaortic adhesions, severe aortic calcifications, and low ejection fraction.
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Affiliation(s)
- Cengiz Bolcal
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Murat Kadan
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Gökhan Erol
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Emre Kubat
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Serdar Fırtına
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Tayfun Özdem
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet E İnce
- Department of Cardiovascular Anesthesiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Tuna Demirkıran
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Kubilay Karabacak
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Suat Doğancı
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Vedat Yıldırım
- Department of Cardiovascular Anesthesiology, Gülhane Training and Research Hospital, Ankara, Turkey
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Çaynak B, Sicim H. Routine minimally invasive approach via left anterior mini‐thoracotomy in multivessel coronary revascularization. J Card Surg 2022; 37:769-776. [DOI: 10.1111/jocs.16259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Barış Çaynak
- Department of Cardiovascular Surgery Private Medical Practice İstanbul Turkey
| | - Hüseyin Sicim
- Department of Cardiovascular Surgery Kırklareli Training and Research Hospital Kırklareli Turkey
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Minatoya K. Aggressive strategy to save the brain in a case of acute aortic dissection. J Card Surg 2021; 36:3981-3982. [PMID: 34322913 DOI: 10.1111/jocs.15874] [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: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
The case report by Sicim et al. is the placement of extra-anatomical bypasses in bilateral common carotid arteries. The similar previous reports of the extra-anatomical bypass usually indicate unilateral bypass. Whether or not the Willis' circle is incomplete is difficult to judge during emergency surgery, and the authors' judgment seems to have been correct in the sense that it could maintain cerebral perfusion reliably and quickly. The direct perfusion and extra-anatomical bypass of the carotid artery is a reasonable strategy in patients with cerebral malperfusion.
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Affiliation(s)
- Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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