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Albano G, Agnino A, Parrinello M, Roscitano C, Cecconi M, Graniero A, Grazioli V, Peluso L. Early Postoperative Complications of Robotic-assisted Versus Minimally Invasive Mitral Valve Surgery: A Propensity Score-matched Analysis. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00358-6. [PMID: 38942684 DOI: 10.1053/j.jvca.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/20/2024] [Accepted: 05/20/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE The current work was designed to evaluate whether robotic-assisted mitral valve surgery is associated with a different incidence of early postoperative complications compared with the traditional minimally invasive approach. DESIGN A retrospective monocentric cohort study was conducted. SETTING The study was performed in an academic hospital. PARTICIPANTS A total of 375 patients who underwent standard thoracoscopic minimally invasive mitral valve surgery and robotic-assisted mitral valve surgery between April 2014 and November 2022 were enrolled. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS After adjustment using propensity score analysis, 98 patients from each group were identified. Patients who underwent robotic surgery presented a similar rate of early complications to patients undergoing minimally invasive surgery. Nevertheless, they showed shorter intensive care unit and postoperative hospital stays. Finally, patients undergoing robotic-assisted surgery were more frequently discharged home. CONCLUSIONS This study identified a similar incidence of early complications in robotic-assisted mitral valve surgery compared with minimally invasive mitral valve surgery; conversely, patients receiving robotic-assisted surgery were discharged earlier, and more frequently discharged home.
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Affiliation(s)
- Giovanni Albano
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Alfonso Agnino
- Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Matteo Parrinello
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Claudio Roscitano
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via M. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Ascanio Graniero
- Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Valentina Grazioli
- Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy
| | - Lorenzo Peluso
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125, Bergamo, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072, Pieve Emanuele, Milan, Italy.
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Grazioli V, Giroletti L, Graniero A, Albano G, Mazzoni M, Panisi PG, Gerometta P, Anselmi A, Agnino A. Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery. J Cardiovasc Med (Hagerstown) 2023; 24:184-190. [PMID: 36409631 DOI: 10.2459/jcm.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIMS Minimally invasive mitral valve surgery leads to shorter postoperative recovery time, cosmetic advantages and significant pain reduction compared with the standard sternotomy approach. Both an external aortic clamp and an endoaortic balloon occlusion can be used to manage the ascending aorta and the myocardial protection. In this study, we aimed to compare these two strategies in terms of effectiveness of myocardial protection and associated early postoperative outcomes. METHODS We investigated the retrospective records of prospectively collected data of patients treated by minimally invasive mitral valve surgery from March 2014 to June 2019. A total of 180 cases (78 in the external aortic clamp group and 102 in the endoaortic balloon clamp group) were collected. A propensity weighting analysis was adopted to adjust for baseline variables. RESULTS The endoaortic balloon clamp presented higher EuroSCORE II (higher reoperative surgery rate). The intra- and postoperative data were similar between the two groups: the postoperative troponin-I levels, peak of serum lactates and rate of myocardial infarction were also comparable. The endoaortic clamp group recorded longer operative, cardiopulmonary bypass and cross-clamp times. The external clamp group showed a higher rate of postoperative atrial fibrillation and conduction block. CONCLUSIONS In experienced centers, the use of the endoaortic balloon clamp is safe, reproducible and comparable to the external aortic clamp regarding the effectiveness of myocardial protection: its employment might facilitate minimally invasive mitral valve surgery.
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Affiliation(s)
| | - Laura Giroletti
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
| | - Ascanio Graniero
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Maurizio Mazzoni
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Alfonso Agnino
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
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Agnino A, Graniero A, Villari N, Roscitano C, Gerometta P, Albano G, Anselmi A. Evaluation of robotic-assisted mitral surgery in a contemporary experience. J Cardiovasc Med (Hagerstown) 2022; 23:399-405. [PMID: 35645031 DOI: 10.2459/jcm.0000000000001319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To evaluate the safety/effectiveness of a recently established robotic-assisted mitral surgery program. METHODS Cohort study with prospective collection of clinical data of 59 consecutive recipients (May 2019-August 2021) of robotic-assisted (fourth-generation platform, DaVinci X) mitral valve repair for degenerative disease, using a totally endoscopic technique. Patients' selection was based on defined anatomical and clinical criteria. We established a dedicated multidisciplinary protocol to facilitate postoperative fast-tracking, and a systematic in-house clinical and echocardiographic follow-up at 3, 6, and 12 postoperative months. RESULTS All patients (89.8% men, average age 58 ± 12 years) received mitral valve repair; there was no operative mortality, one conversion to sternotomy (1.7%) and one stroke (1.7%). Extubation within the operative theater occurred in 28.8%; average mechanical ventilation time and ICU stay was 2.8 ± 4.1 and 32.5 ± 15.8 h (after exclusion of one outlier, learning-curve period, suffering from perioperative stroke); average postoperative hospital stay was 6.8 ± 3.4 days and 96.6% of patients were discharged home. One patient was transfused (1.7%); there were no other complications. Follow-up revealed stability of the results of mitral repair, with one (1.7%) persistent (>2+/4+) mitral regurgitation, and stability of coaptation height over time. We observed optimal functional results (class I was 98% at 3 months and 96% at 12 months). Quarterly case load consistently increased during the experience. CONCLUSION This initial experience suggests the reliability and clinical safety of a recently established local robotic-assisted mitral surgery. This strategy can facilitate faster postoperative recovery, and its positioning in the therapeutic armamentarium needs to be defined.
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Affiliation(s)
- Alfonso Agnino
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery
| | - Ascanio Graniero
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery
| | - Nicola Villari
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | | | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche HUMANITAS Gavazzeni, Bergamo, Italy
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital.,Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
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D'Ortona R, Di Pasquale M, Maccagni G, Adamo M, Metra M. Highlights in valvular heart diseases. J Cardiovasc Med (Hagerstown) 2020; 21:925-926. [PMID: 33136812 DOI: 10.2459/jcm.0000000000001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Renzo D'Ortona
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
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Agnino A, Albano G, Ruggieri VG, Roscitano C, Graniero A, Villari N, Giroletti L, Anselmi A. Versatility of endoaortic balloon occlusion device for less invasive management of complex and reoperative cardiac cases. J Card Surg 2019; 34:620-623. [PMID: 31212364 DOI: 10.1111/jocs.14115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/23/2019] [Indexed: 11/29/2022]
Abstract
Heart Teams are increasingly confronted with decision-making in anatomically and clinically complex surgical candidates. Herein, we discuss the versatility of the endoaortic occlusion device (Intraclude; Edwards Lifesciences Inc) for the management of a various array of complex primary and reoperative cardiac cases. Three clinical scenarios are illustrated (ascending aortic pseudoaneurysm, mitral valve surgery after previous CABG, extensive thoracic aortic surgery with continuous visceral perfusion), suggesting the effectiveness of the patient-specific strategy to minimize operative morbidity. Evolution of surgical techniques needs to be considered in decision-making among alternative treatment strategies.
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Affiliation(s)
- Alfonso Agnino
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Giovanni Albano
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Vito G Ruggieri
- Division of Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France
| | - Claudio Roscitano
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Ascanio Graniero
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Nicola Villari
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Laura Giroletti
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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