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Bonatti J. Robotically assisted internal mammary artery harvesting-will single-port systems be useful? INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae107. [PMID: 38845068 PMCID: PMC11165269 DOI: 10.1093/icvts/ivae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Affiliation(s)
- Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and UPMC Heart and Vascular Institute, Pittsburgh, PA, USA
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2
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Vento V, Kuntz S, Lejay A, Chakfe N. Evolutionary trends and innovations in cardiovascular intervention. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1384008. [PMID: 38756327 PMCID: PMC11098563 DOI: 10.3389/fmedt.2024.1384008] [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: 02/08/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Cardiovascular diseases remain a global health challenge, prompting continuous innovation in medical technology, particularly in Cardiovascular MedTech. This article provides a comprehensive exploration of the transformative landscape of Cardiovascular MedTech in the 21st century, focusing on interventions. The escalating prevalence of cardiovascular diseases and the demand for personalized care drive the evolving landscape, with technologies like wearables and AI reshaping patient-centric healthcare. Wearable devices offer real-time monitoring, enhancing procedural precision and patient outcomes. AI facilitates risk assessment and personalized treatment strategies, revolutionizing intervention precision. Minimally invasive procedures, aided by robotics and novel materials, minimize patient impact and improve outcomes. 3D printing enables patient-specific implants, while regenerative medicine promises cardiac regeneration. Augmented reality headsets empower surgeons during procedures, enhancing precision and awareness. Novel materials and radiation reduction techniques further optimize interventions, prioritizing patient safety. Data security measures ensure patient privacy in the era of connected healthcare. Modern technologies enhance traditional surgeries, refining outcomes. The integration of these innovations promises to shape a healthier future for cardiovascular procedures, emphasizing collaboration and research to maximize their transformative potential.
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Affiliation(s)
- Vincenzo Vento
- Vascular Surgery Department, Lancisi Cardiovascular Center, Ancona, Italy
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Department of Vascular Surgery, Kidney Transplantation and Innovation, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Department of Vascular Surgery, Kidney Transplantation and Innovation, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- Department of Vascular Surgery, Kidney Transplantation and Innovation, University Hospital of Strasbourg, Strasbourg, France
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3
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Saad EA, Mukherjee T, Gandour G, Fatayerji N, Rammal A, Samuel P, Abdallah N, Ashok T. Cardiac myxomas: causes, presentations, diagnosis, and management. Ir J Med Sci 2024; 193:677-688. [PMID: 37737916 DOI: 10.1007/s11845-023-03531-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.
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Affiliation(s)
- Elio Assaad Saad
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Tishya Mukherjee
- Faculty of Medicine, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Moldova
| | - Georges Gandour
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Nora Fatayerji
- Faculty of Medicine and Medical Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Aya Rammal
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Peter Samuel
- International Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.
| | - Nicolas Abdallah
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
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4
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Massey J, Palmer K, Al-Rawi O, Chambers O, Ridgway T, Shanmuganathan S, Soppa G, Modi P. Robotic mitral valve surgery. Front Cardiovasc Med 2024; 10:1239742. [PMID: 38505666 PMCID: PMC10948479 DOI: 10.3389/fcvm.2023.1239742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/19/2023] [Indexed: 03/21/2024] Open
Abstract
Totally endoscopic robotic mitral valve repair is the least invasive surgical therapy for mitral valve disease. Robotic mitral valve surgery demonstrates faster recovery with shorter hospital stays, less morbidity, and equivalent mortality and mid-term durability compared to sternotomy. In this review, we will explore the advantages and disadvantages of robotic mitral valve surgery and consider important technical details of both operative set-up and mitral valve repair techniques. The number of robotic cardiac surgical procedures being performed globally is expected to continue to rise as experience grows with robotic techniques and increasing numbers of cardiac surgeons become proficient with this innovative technology. This will be facilitated by the introduction of newer robotic systems and increasing patient demand.
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Affiliation(s)
| | | | | | | | | | | | | | - Paul Modi
- Department of Cardiothoracic Surgery, The Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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5
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Algoet M, Verbelen T, Jacobs S, De Praetere H, Marynissen M, Oosterlinck W. Robot-Assisted MIDCAB Using Bilateral Internal Thoracic Artery: A Propensity Score-Matched Study With OPCAB Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:184-191. [PMID: 38952215 DOI: 10.1177/15569845241245422] [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] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) is an attractive strategy for coronary revascularization. Growing evidence supports the use of total arterial grafting in coronary surgery. We evaluated total arterial left-sided coronary revascularization with bilateral internal thoracic artery (BITA) using RA-MIDCAB and compared it with a propensity score-matched (PSM) off-pump CAB (OPCAB) surgery population. METHODS We retrospectively included all isolated OPCAB and RA-MIDCAB surgery using BITA without saphenous vein graft from January 1, 2015, to October 31, 2022. We analyzed all our RA-MIDCAB patients and performed PSM to compare them with our OPCAB population. Primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE) and mortality. Secondary outcomes were surgical parameters, length of hospital stay, and learning curve. RESULTS We included 601 OPCAB and 77 RA-MIDCAB procedures, which resulted in 2 cohorts of 54 patients after PSM. Mortality and MACCE survival analysis showed no significant difference. There was less blood transfusion in the RA-MIDCAB (16.7%) compared with the OPCAB group (38.9%; P = 0.02). We observed fewer intensive care unit (ICU) admissions (24.1% vs 96.6%), shorter ICU stay (0.78 ± 1.7 vs 1.91 ± 1.01 days), and shorter hospital stay (6.78 ± 2.4 vs 8.01 ± 2.5 days) in the RA-MIDCAB versus OPCAB group (P < 0.01). Surgery time decreased from 400.0 ± 70.8 to 325.0 ± 38.0 min with more experience in RA-MIDCAB BITA harvesting (P < 0.01). CONCLUSIONS This is a first publication of 77 consecutive RA-MIDCAB BITA harvesting for left coronary artery system revascularization. This technique is safe in terms of MACCE and mortality. Additional advantages are shorter length of hospital stay, fewer ICU admissions, and less blood transfusion.
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Affiliation(s)
- Michiel Algoet
- Department of Cardiovascular Sciences, Research Unit Cardiac Surgery, KU Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiovascular Sciences, Research Unit Cardiac Surgery, KU Leuven, Belgium
| | - Steven Jacobs
- Department of Cardiovascular Sciences, Research Unit Cardiac Surgery, KU Leuven, Belgium
| | | | | | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, Research Unit Cardiac Surgery, KU Leuven, Belgium
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6
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Beyersdorf F. Innovation and disruptive science determine the future of cardiothoracic surgery. Eur J Cardiothorac Surg 2024; 65:ezae022. [PMID: 38243711 DOI: 10.1093/ejcts/ezae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
One of the currently most asked questions in the field of medicine is how any specialty in the future will evolve to ensure better health for the patients by using current, unparalleled developments in all areas of science. This article will give an overview of new and evolving strategies for cardiothoracic (CT) surgery that are available today and will become available in the future in order to achieve this goal. In the founding era of CT surgery in the 1950s and 1960s, there was tremendous excitement about innovation and disruptive science, which eventually resulted in a completely new medical specialty, i.e. CT surgery. Entirely new treatment strategies were introduced for many cardiovascular diseases that had been considered incurable until then. As expected, alternative techniques have evolved in all fields of science during the last few decades, allowing great improvements in diagnostics and treatment in all medical specialties. The future of CT surgery will be determined by an unrestricted and unconditional investment in innovation, disruptive science and our own transformation using current achievements from many other fields. From the multitude of current and future possibilities, I will highlight 4 in this review: improvements in our current techniques, bringing CT surgery to low- and middle-income countries, revolutionizing the perioperative period and treating as yet untreatable diseases. These developments will allow us a continuation of the previously unheard-of treatment possibilities provided by ingenious innovations based on the fundamentals of CT surgery.
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Affiliation(s)
- Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany
- Medical Faculty of the Albert-Ludwigs-University Freiburg, Germany
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7
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Wan S, Zhao Q, Wang CS. Commentary: Robotic mitral repair: The "new gold-standard" that requires more gold. J Thorac Cardiovasc Surg 2024; 167:645-646. [PMID: 35752475 DOI: 10.1016/j.jtcvs.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun-Sheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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8
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Tasoudis PT, Caranasos TG, Doulamis IP. Robotic applications for intracardiac and endovascular procedures. Trends Cardiovasc Med 2024; 34:110-117. [PMID: 36273775 DOI: 10.1016/j.tcm.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/01/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
The large incisions and long recovery periods that accompany traditional cardiac surgery procedures along with the constant patient demand for minimally invasive procedures have motivated cardiac surgeons to implement the robotic technologies in their armamentarium. The robotic systems have been utilized successfully in various cardiac procedures including atrial septal defect repair, left atrial myxoma resection, MAZE procedure and left ventricular lead placement, yet coronary artery bypass and mitral valve repair still comprise the vast majority of them. This review analyzes the development of the robot-assisted cardiac surgery in recent years, its outcomes, advantages, disadvantages, its patient selection criteria as well as its economic feasibility. Robotic endovascular surgery, albeit its limited applications, is presently considered an attractive alternative to conventional endovascular approaches. The increased flexibility and precision along with the wider range of accessible anatomy provided by the endovascular robotic systems, have increased the pool of patients that can be offered minimally invasive treatment options and have helped to overcome many limitations of the traditional endovascular procedures. With this review we aimed to summarize the applications of the commercially available endovascular robotic devices, as well as the limitations and the future perspectives in the field of endovascular robotic surgery.
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Affiliation(s)
- Panagiotis T Tasoudis
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, NC, United States
| | - Thomas G Caranasos
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, NC, United States
| | - Ilias P Doulamis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Mainwaring E, Patel R, Desai C, Acharya R, Raveshia D, Shah S, Panesar H, Patel N, Singh R. Five historical innovations that have shaped modern cardiothoracic surgery. J Perioper Pract 2023:17504589231212967. [PMID: 38149619 DOI: 10.1177/17504589231212967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Throughout history, many innovations have contributed to the development of modern cardiothoracic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern cardiothoracic surgery: cardiopulmonary bypass, surgical pacemakers, video assisted thoracic surgery, robotic surgery and mechanical circulatory support. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of cardiothoracic surgery and their ongoing relevance in contemporary and perioperative practice.
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Affiliation(s)
- Elizabeth Mainwaring
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital, Cambridge, UK
| | - Ravi Patel
- Department of Trauma and Orthopaedics, Shrewsbury and Telford Trust, The Princess Royal Hospital, Telford, UK
- Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Chaitya Desai
- Department of Urology, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK
| | - Radhika Acharya
- Department of Intensive Care, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dimit Raveshia
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saumil Shah
- Department of Otolaryngology, The Princess Royal Hospital, Telford, UK
| | - Harrypal Panesar
- Department of Otolaryngology, The Princess Royal Hospital, Telford, UK
| | | | - Rohit Singh
- Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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10
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Lee ME, Amabile A, LaLonde M, Krane M, Geirsson A, Gruber PJ. Minimally invasive, robotic-assisted approach for mitral valve replacement in a pediatric congenital patient with severe mitral regurgitation. JTCVS Tech 2023; 22:94-95. [PMID: 38152178 PMCID: PMC10750875 DOI: 10.1016/j.xjtc.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Madonna E. Lee
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Michael LaLonde
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Markus Krane
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Peter J. Gruber
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
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11
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Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D, Rodriguez Cetina Biefer H, Dzemali O. Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery. J Clin Med 2023; 12:7210. [PMID: 38068262 PMCID: PMC10707549 DOI: 10.3390/jcm12237210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 06/26/2024] Open
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.
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Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
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12
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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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13
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Holubec T, Dahle G, Bonaros N. Editorial: Minimally invasive cardiac surgery: state of the art and current challenges. Front Cardiovasc Med 2023; 10:1286868. [PMID: 37829692 PMCID: PMC10565476 DOI: 10.3389/fcvm.2023.1286868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- Tomas Holubec
- Department of Cardiovascular Surgery, Goethe University and University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Gry Dahle
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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14
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Sandoval E, Muro A, Navarro R, García-Álvarez A, Castellà M, Pereda D. Implementation and clinical impact of a robotic heart surgery program. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:739-741. [PMID: 37182723 DOI: 10.1016/j.rec.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Elena Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Anna Muro
- Servicio de Cirugía Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Ricard Navarro
- Servicio de Anestesiología, Hospital Clínic, Barcelona, Spain
| | - Ana García-Álvarez
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Castellà
- Servicio de Cirugía Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Daniel Pereda
- Servicio de Cirugía Cardiovascular, Hospital Clínic, Barcelona, Spain; Servicio de Cardiología, Hospital Clínic, Barcelona, Spain.
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15
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AlJamal YN, Burgin R, Kitahara H, Gonzalez G, Balkhy HH. Inexpensive and Easy to Set Up Robotic Cardiac Simulator Offers "Unlimited" Endoscopic Coronary Artery Bypass Grafting Experience: Proof of Concept. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:419-423. [PMID: 37753828 DOI: 10.1177/15569845231199997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Robotic totally endoscopic coronary artery bypass (TECAB) grafting is the least invasive form of coronary bypass surgery. However, despite its advantages, this approach has not gained widespread adoption. One possible reason is the advanced and complex robotic skills required to execute a totally endoscopic sutured coronary anastomosis. We prepared a novel, inexpensive, easy to set up robotic TECAB simulator. METHODS A pig heart was placed in a cardboard box, and 3 holes were made on the side to mimic the exposure and surgical ergonomics of TECAB port placement. Four robotic ports were placed and docked to the da Vinci Si robot (Intuitive Surgical, Sunnyvale, CA, USA). Monofilament 7:0 suture (7 cm long) was used to perform the anastomosis to the left anterior descending artery using remnant conduit. Seven cardiac surgeons of various training levels participated and were asked to fill out a 10-point questionnaire. RESULTS The cost of the simulator totaled $20 per session, with 20 min to assemble. Each session allowed each trainee to practice 3 to 4 coronary anastomoses. Three cardiac surgeons completed the survey and strongly agreed that the model was easy to set up, the anastomotic exercise was realistic, and that this practice helped them gain confidence. CONCLUSIONS Our TECAB simulator is inexpensive, easy to set up, and allows trainees to practice endoscopic coronary suturing. We believe this to be a valuable training tool to learn how to do TECAB for established surgeons and that such a simulator may be of great value to cardiothoracic training programs and their trainees. Further studies are warranted.
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Affiliation(s)
- Yazan N AlJamal
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert Burgin
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
| | - Hiroto Kitahara
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
| | - Gabriela Gonzalez
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
| | - Husam H Balkhy
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
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16
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Giroletti L, Brembilla V, Graniero A, Albano G, Villari N, Roscitano C, Parrinello M, Grazioli V, Lanzarone E, Agnino A. Learning Curve Analysis of Robotic-Assisted Mitral Valve Repair with COVID-19 Exogenous Factor: A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1568. [PMID: 37763687 PMCID: PMC10536190 DOI: 10.3390/medicina59091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background and objective Renewed interest in robot-assisted cardiac procedures has been demonstrated by several studies. However, concerns have been raised about the need for a long and complex learning curve. In addition, the COVID-19 pandemic in 2020 might have affected the learning curve of these procedures. In this study, we investigated the impact of COVID-19 on the learning curve of robotic-assisted mitral valve surgery (RAMVS). The aim was to understand whether or not the benefits of RAMVS are compromised by its learning curve. Materials and Methods Between May 2019 and March 2023, 149 patients underwent RAMVS using the Da Vinci® X Surgical System at the Humanitas Gavazzeni Hospital, Bergamo, Italy. The selection of patients enrolled in the study was not influenced by case complexity. Regression models were used to formalize the learning curves, where preoperative data along with date of surgery and presence of COVID-19 were treated as the input covariates, while intraoperative and postoperative data were analyzed as output variables. Results The age of patients was 59.1 ± 13.3 years, and 70.5% were male. In total, 38.2% of the patients were operated on during the COVID-19 pandemic. The statistical analysis showed the positive impact of the learning curve on the trend of postoperative parameters, progressively reducing times and other key indicators. Focusing on the COVID-19 pandemic, statistical analysis did not recognize an impact on postoperative outcomes, although it became clear that variables not directly related to the intervention, especially ICU hours, were strongly influenced by hospital logistics during COVID-19. Conclusions Understanding the learning curve of robotic surgical procedures is essential to ensure their effectiveness and benefits. The learning curve involves not only surgeons but also other health care providers, and establishing a stable team in the early stage, as in our case, is important to shorten the duration. In fact, an exogenous factor such as the COVID-19 pandemic did not affect the robotic program despite the fact that the pandemic occurred early in the program.
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Affiliation(s)
- Laura Giroletti
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Valentina Brembilla
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Ascanio Graniero
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Nicola Villari
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Matteo Parrinello
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Valentina Grazioli
- Cardiovascular Surgery Department, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy;
| | - Ettore Lanzarone
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Alfonso Agnino
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
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17
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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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18
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Tomšič A, Palmen M. Robotic mitral valve repair surgery: where do we go from here? Front Cardiovasc Med 2023; 10:1156495. [PMID: 37293277 PMCID: PMC10244781 DOI: 10.3389/fcvm.2023.1156495] [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: 02/01/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Surgical mitral valve repair through median sternotomy has long presented the treatment of choice for degenerative mitral valve disease. In recent decades, minimal invasive surgical techniques have been developed and are now gaining widespread popularity. Robotic cardiac surgery presents an emerging field, initially adopted only by selected centres, mostly in the United States. In recent years, the number of centers interested in robotic mitral valve surgery has grown with an increasing adoption in Europe as well. Increasing interest and surgical experience gained are stimulating further developments in the field and the full potential of robotic mitral valve surgery remains to be developed.
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19
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Liu Y, Liu Z, Li X, Jiang Y, Lu C, Zhang C, Ge S. A comparison of total thoracoscopic versus robotic approach for cardiac myxoma resection: a single-center retrospective study. J Robot Surg 2023:10.1007/s11701-023-01531-z. [PMID: 36648634 PMCID: PMC10374789 DOI: 10.1007/s11701-023-01531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
Advances in instrumentation and technique have facilitated minimally invasive surgeries for cardiac myxoma treatment. This study aims to compare the clinical outcomes between the thoracoscopic and robotic approaches for myxoma resection. Intraoperative data and postoperative data of 46 patients who underwent either thoracoscopic (n = 15) or robotic (n = 31) cardiac myxoma resection in our center between July 2013 and September 2022 were retrospectively compared. There was no in-hospital death in either group. Meanwhile, the operative time and cardiopulmonary bypass time were significantly shorter in the robotic group than in thoracoscopic group (P = 0.015 and P = 0.035, respectively). Furthermore, shorter ICU stays (P = 0.006), shorter postoperative mechanical ventilation time (P = 0.035) and less thoracic drainage (P = 0.040) were observed in the robotic group. However, the operating room costs and total hospital costs were both significantly lower in thoracoscopic group (P = 0.004 and P = 0.007, respectively). There was no significant difference between two groups regarding the incidence of postoperative complications (P > 0.05). Lastly, a faster return to exercise was noted in robotic group than in thoracoscopic group (Log-Rank χ2 = 4.094, P = 0.043). Both approaches can be safe and feasible for myxoma resection. However, regardless of higher expenses, the robotic myxoma resection approach provides shorter operation time, less postoperative thoracic drainage, and faster recovery than total thoracoscopic technique.
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Affiliation(s)
- Yanyi Liu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Zhuang Liu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Xin Li
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Yiyao Jiang
- Department of Cardiac Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, Anhui, China
| | - Chenghao Lu
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China
| | - Chengxin Zhang
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China.
| | - Shenglin Ge
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, China.
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20
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Oosterlinck W, Algoet M, Balkhy HH. Minimally Invasive Coronary Surgery: How Should It Be Defined? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:22-27. [PMID: 36762801 DOI: 10.1177/15569845231153366] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Wouter Oosterlinck
- Department of Cardiovascular Sciences, Research Unit of Cardiac Surgery, KU Leuven, Belgium
| | - Michiel Algoet
- Department of Cardiovascular Sciences, Research Unit of Cardiac Surgery, KU Leuven, Belgium
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
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21
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Palmen M, Navarra E, Bonatti J, Franke U, Cerny S, Musumeci F, Modi P, Singh S, Sandoval E, Pettinari M, Segers P, Gianoli M, van Praet F, de Praetere H, Vojacek J, Cebotaru T, Onan B, Bolcal C, Alhan C, Ouda A, Melly L, Malapert G, Labrousse L, Agnino A, Phillipsen T, Jansens JL, Folliguet T, Suwalski P, Cathenis K, Doguet F, Tomšič A, Oosterlinck W, Pereda D. Current state of the art and recommendations in robotic mitral valve surgery. Interact Cardiovasc Thorac Surg 2022; 35:ivac160. [PMID: 35748726 PMCID: PMC9724768 DOI: 10.1093/icvts/ivac160] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 09/29/2023] Open
Affiliation(s)
| | | | - Johannes Bonatti
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| | | | | | | | - Paul Modi
- Liverpool Heart and Chest, Liverpool, United Kingdom
| | | | | | | | - Patrique Segers
- Maastricht University Medical Center, Maastricht, Netherlands
| | | | | | | | - Jan Vojacek
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Burak Onan
- Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cengiz Bolcal
- Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | - Ahmed Ouda
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | - Thierry Folliguet
- Henri MONDOR Hospital, Assistance Publique Hopitaux de Paris, Creteil, France
| | - Piotr Suwalski
- Central Clinical Hospital of the Ministry of the Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Fabien Doguet
- Cardiovascular Institute Paris Sud, Private Hospital Jacques Cartier, Massy, France
| | - Anton Tomšič
- Leiden University Medical Centre, Leiden, Netherlands
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
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22
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Franke UFW, Huether F, Ghinescu M, Ortega Gaviria M, Rufa MI, Albert M, Ursulescu A, Goebel N. Robotically assisted mitral valve surgery-experience during the restart of a robotic program in Germany. Ann Cardiothorac Surg 2022; 11:596-604. [PMID: 36483620 PMCID: PMC9723532 DOI: 10.21037/acs-2022-rmvs-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/14/2022] [Indexed: 04/08/2024]
Abstract
BACKGROUND Following the first robotic-assisted mitral valve operations in Paris and Leipzig, the era of this innovative technique expired after a few years in Germany. At that time, the main arguments against robotic surgery within the German cardiac surgical community were low cost effectiveness and operative time utilization. Encouraged by favorable results, we re-started our robotic-assisted cardiac program as the first and only center in Germany in 2019. METHODS Between July 2019 and December 2021, 329 patients underwent robotic-assisted operations using the daVinci Xi system, including mitral and coronary operations, myxoma resection, atrial septal closure and stand-alone atrial ablation. Of these, 182 patients underwent mitral valve repair (MVR). Isolated MVR was performed in 96 patients (isolated mitral group, IMG) and 86 underwent concomitant operations, such as tricuspid valve repair, Cox-Maze IV, pulmonary vein isolation (PVI) and left atrial appendage (LAA) closure (complex mitral group, CMG). For cost analysis, the InEK calculation for 2020 was used. RESULTS MVR was successful (MR ≤I°) in all patients. Patients in the IMG had a hospital mortality of 1.0% (O/E ratio 0.69) and stroke rate of 2.0%. Four patients (4.0%) required conversion to sternotomy and 6 patients (6.0%) needed re-exploration for bleeding. Mortality was 3.5% (O/E ratio 0.74) in the CMG and stroke rate 2.3%. The conversion and bleeding rates were 4.6% each, respectively. The steep learning curve resulted in significant reduction of operating times greater than 25% in the IMG. Comparing the results of robotic-assisted procedures to minimally-invasive mitral surgeries (MIMS) in 2020, a reduction in length of hospital stay of almost 25% resulted in significantly lower costs for the medical service and medical infrastructure. However, within the German health service, overall cost for robotic-assisted procedures were more expensive compared to MIMS by 5% due to higher material costs. CONCLUSIONS The re-establishment of robotic mitral valve surgery in Germany was successful with comparable results to MIMS in terms of mortality and morbidity. Robotic-assisted cardiac operations resulted in accelerated postoperative recovery with significant shortening of the hospital length of stay. The avoidance of liver injury is one focus for the future.
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Affiliation(s)
- Ulrich F W Franke
- Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Franziska Huether
- Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Mihnea Ghinescu
- Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Melisa Ortega Gaviria
- Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Magdalena I Rufa
- Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Marc Albert
- Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Adrian Ursulescu
- Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Nora Goebel
- Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
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23
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Chitwood WR. Historical evolution of robot-assisted cardiac surgery: a 25-year journey. Ann Cardiothorac Surg 2022; 11:564-582. [PMID: 36483613 PMCID: PMC9723535 DOI: 10.21037/acs-2022-rmvs-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/05/2022] [Indexed: 08/18/2023]
Abstract
Many patients and surgeons today favor the least invasive access to an operative site. The adoption of robot-assisted cardiac surgery has been slow, but now has come to fruition. The development of modern surgical robots took surgeons close collaboration with mechanical, electrical, and optical engineers. Moreover, the necessary project funding required entrepreneurs, federal grants, and venture capital. Non-robotic minimally invasive cardiac surgery paved the way to the application of surgical robots by making changes in operative approaches, instruments, visioning modalities, cardiopulmonary perfusion techniques, and especially surgeons' attitudes. In this article, the serial development of robot-assisted cardiac surgery is detailed from the beginning and through clinical application. Included are references to the historical and most recent clinical series that have given us the evidence that robot-assisted cardiac surgery is safe and provides excellent outcomes. To this end, in many institutions these procedures now have become a new standard of care. This evolution reflects Sir Isaac Newton's famous 1676 quote when referring to Rene Descartes, "If have seen further [sic] than others, it is by standing on the shoulders of giants".
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Affiliation(s)
- W Randolph Chitwood
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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24
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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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25
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Gofus J, Cerny S, Shahin Y, Sorm Z, Vobornik M, Smolak P, Sethi A, Marcinov S, Karalko M, Chek J, Harrer J, Vojacek J, Pojar M. Robot-assisted vs. conventional MIDCAB: A propensity-matched analysis. Front Cardiovasc Med 2022; 9:943076. [PMID: 36110419 PMCID: PMC9468449 DOI: 10.3389/fcvm.2022.943076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Robotic assistance (RA) in the harvesting of internal thoracic artery during minimally invasive direct coronary artery bypass grafting (MIDCAB) provides several potential benefits for surgeon and patient in comparison with conventional MIDCAB. The two technical options have not been thoroughly compared in the literature yet. We aimed to perform this in our cohort with the use of propensity-score matching (PSM). Methods This was a retrospective comparison of all consecutive patients undergoing conventional MIDCAB (2005–2021) and RA-MIDCAB (2018–2021) at our institution with the use of PSM with 27 preoperative covariates. Results Throughout the study period 603 patients underwent conventional and 132 patients underwent RA-MIDCAB. One hundred and thirty matched pairs were selected for further comparison. PSM successfully eliminated all preoperative differences. Patients after RA-MIDCAB had lower 24 h blood loss post-operatively (300 vs. 450 ml, p = 0.002). They had shorter artificial ventilation time (6 vs. 7 h, p = 0.018) and hospital stay (6 vs. 8 days, p < 0.001). There was no difference in the risk of perioperative complications, short-term and mid-term mortality between the groups. Conclusions RA-MIDCAB is an attractive alternative to conventional MIDCAB. It is associated with lower post-operative blood loss and potentially faster rehabilitation after surgery. The mortality and the risk of perioperative complications are comparable among the groups.
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26
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Pettinari M, Gianoli M, Palmen M, Cerny S, Onan B, Singh S, Segers P, Bolcal C, Alhan C, Navarra E, De Praetere H, Vojacek J, Cebotaru T, Modi P, Doguet F, Franke U, Ouda A, Melly L, Malapert G, Labrousse L, Agnino A, Philipsen T, Jansens JL, Folliguet T, Pereda D, Musumeci F, Suwalski P, Cathenis K, Van Praet F, Bonatti J, Oosterlinck W. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6588518. [PMID: 35587697 PMCID: PMC9525087 DOI: 10.1093/icvts/ivac108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Matto Pettinari
- Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium
- Corresponding author. Ziekenhuis Oost Limburg, Sciepse Bos 6, Genk, Belgium. Tel: +32-89327077; e-mail: (M. Pettinari)
| | - Monica Gianoli
- Department of Cardiac Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Meindert Palmen
- Department of Cardiac Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Burak Onan
- Department of Cardiac Surgery, Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sandeep Singh
- Department of Cardiac Surgery, ISALA Hospital, Zwolle, Netherlands
| | - Patrique Segers
- Department of Cardiac Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Cengiz Bolcal
- Department of Cardiac Surgery, Gulhane Education ve Research Hospital, Ankara, Turkey
| | - Cem Alhan
- Department of Cardiac Surgery, Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
| | - Emiliano Navarra
- Department of Cardiac Surgery, Cliniques Univesitaires Saint Luc, Brussels, Belgium
| | - Herbert De Praetere
- Department of Cardiac Surgery, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Jan Vojacek
- Department of Cardiac Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Theodor Cebotaru
- Department of Cardiac Surgery, MONZA Hospital, Bucharest, Romania
| | - Paul Modi
- Department of Cardiac Surgery, Liverpool Heart and Chest, Liverpool, United Kingdom
| | - Fabien Doguet
- Department of Cardiac Surgery, Private Hospital Jacques Cartier, Massy, France
| | - Ulrich Franke
- Department of Cardiac Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ahmed Ouda
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ludovic Melly
- Department of Cardiac Surgery, CHU UCL Namur—Site Godinne, Namur, Belgium
| | | | - Louis Labrousse
- Department of Cardiac Surgery, University Hospital Bordeaux, Bordeaux, France
| | - Alfonso Agnino
- Department of Cardiac Surgery, Humanitas Gavazzeni, Bergamo, Italy
| | - Tine Philipsen
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Jean-Luc Jansens
- Department of Cardiac Surgery, Erasme Hospital Brussels, Brussels, Belgium
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpital Henri MONDOR, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France
| | - Daniel Pereda
- Department of Cardiac Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Piotr Suwalski
- Department of Cardiac Surgery, Central Teaching Hospital of the Ministry of the Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Koen Cathenis
- Department of Cardiac Surgery, AZ Maria Middelares, Ghent, Belgium
| | - Frank Van Praet
- Department of Cardiac Surgery, Cardiovascular Center, OLV Clinic, Aalst, Belgium
| | - Johannes Bonatti
- Department of Cardiac Surgery, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, University Hospital Leuven, KU Leuven, Leuven, Belgium
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