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Zacharias J, Glauber M, Pitsis A, Solinas M, Kempfert J, Castillo-Sang M, Balkhy HH, Perier P. The 7 Pillars of Starting an Endoscopic Cardiac Surgery Program. Innovations (Phila) 2024:15569845241239448. [PMID: 38619021 DOI: 10.1177/15569845241239448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
| | | | | | - Marco Solinas
- Ospedale del Cuore-Fondazione Monasterio, Massa, Italy
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AlJamal YN, Kitahara H, Johnson B, Grady K, Balkhy HH. Routine External Iliac Artery Cannulation in Robotic Cardiac Surgery: Role of the Corona "Vitae" in Distal Limb Perfusion. Innovations (Phila) 2024:15569845241239911. [PMID: 38606852 DOI: 10.1177/15569845241239911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Femoral artery cannulation is the most commonly used approach for cardiopulmonary bypass (CPB) in robotic cardiac procedures. However, without adding a distal perfusion cannula, leg ischemia can occur in up to 11.5% of patients. There is a well-described 2 to 4 mm size arterial branch that originates from the medial side of the external iliac artery or inferior epigastric artery, immediately above the inguinal ligament, and connects to the obturator artery. Therefore, it was historically named the corona mortis, which means "crown of death" in Latin. When peripheral cannulation is performed above this branch in the external iliac artery, we consider it a corona "vitae" because of its role as a limb-saving collateral. We report herein our standard technique of peripheral cannulation without the need of a distal perfusion cannula and preventing limb ischemia. METHODS We included all patients who underwent robotic cardiac surgery with peripheral cannulation over a 16-month period at our institution. We cannulated just above the level of the inguinal ligament through a 2 to 3 cm transverse skin incision. The incidence of limb ischemia and vascular complications was recorded and analyzed. RESULTS During the study period, 133 patients underwent robotic cardiac procedures with peripheral "external iliac" CPB. The size of the cannula was 21F or larger in 73% and 23F in 54% of the patients. No leg ischemia or femoral artery complications requiring additional intervention occurred. CONCLUSIONS External iliac cannulation can be successfully performed in robot-assisted cardiac surgery using relatively large cannulas without the need of a distal limb perfusion catheter, with good results. In our view, given the importance of the corona mortis ("crown of death" in Latin) in perfusing the limb during CPB, we propose a new name for this artery in robotic cardiac surgery, namely, the corona vitae ("crown of life" in Latin).
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Affiliation(s)
- Yazan N AlJamal
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hiroto Kitahara
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
| | - Blaine Johnson
- Department of Cardiovascular Surgery, University of Chicago, IL, USA
| | - Kaitlin Grady
- 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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Zacharias J, Glauber M, Pitsis A, Solinas M, Kempfert J, Castillo-Sang M, Balkhy HH, Perier P. Endoscopic Cardiac Surgeons Club: The 5 Whys. Innovations (Phila) 2024:15569845241239281. [PMID: 38576094 DOI: 10.1177/15569845241239281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
| | | | | | - Marco Solinas
- Ospedale del Cuore-Fondazione Monasterio, Massa, Italy
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Kitahara H, Grady K, Balkhy HH. Robotic Totally Endoscopic Mitral Valve Repair After Failed MitraClip. Innovations (Phila) 2024:15569845241237801. [PMID: 38504392 DOI: 10.1177/15569845241237801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Hiroto Kitahara
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Kaitlin Grady
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
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Nisivaco S, Kitahara H, Abutaleb A, Nathan S, Balkhy HH. Robotic Totally Endoscopic Coronary Bypass to the Left Anterior Descending Artery: Left Versus Right Internal Thoracic Artery Grafts. J Surg Res 2023; 291:139-150. [PMID: 37390593 DOI: 10.1016/j.jss.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/04/2023] [Accepted: 04/29/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION The left internal thoracic artery (LITA) is most commonly used to bypass the left anterior descending artery (LAD) given its well-established mortality benefit. In some cases, the grafting strategy necessitates placing the right internal thoracic artery (RITA) on the LAD. We compared outcomes in our robotic beating-heart totally endoscopic coronary bypass surgery (TECAB) population between patients receiving LITA versus RITA-LAD grafts. METHODS We retrospectively reviewed patients undergoing robotic TECAB with skeletonized ITA conduits over 9 y. Outcomes were compared between those receiving LITA (Group-1) versus RITA (Group-2) grafts to the LAD (with/without other grafts). End points were early angiographic patency (in patients undergoing hybrid revascularization) and mid-term mortality/major adverse cardiac/cerebrovascular events. A propensity matched subanalysis was performed comparing only patients who received bilateral ITA grafting in each group. RESULTS Society of Thoracic Surgeons predicted mortality risk score was higher in Group-2. Group-1 patients had lower incidence of multivessel disease (75% versus 96%, P ≤ 0.001). Early overall graft patency (97% versus 96%, P = 0.718) and LAD graft patency (98% versus 95%, P = 0.372) were equivalent. At mean 42-mo follow-up (longest 8.5 y), Group-1 had lower all-cause mortality but no difference in cardiac mortality or repeat revascularization. In the propensity matched subanalysis, mid-term outcomes were equivalent. CONCLUSIONS Grafting the LAD with the LITA or RITA during robotic beating-heart TECAB resulted in similar early outcomes and angiographic patency. RITA-LAD patients were more likely to have multivessel disease and higher Society of Thoracic Surgeons risk and had higher all-cause mortality at mid-term analysis but no difference in major adverse cardiac/cerebrovascular events, including cardiac mortality.
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Affiliation(s)
- Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | | | - Sandeep Nathan
- Department of Cardiology, University of Chicago Medicine, Chicago, Illinois
| | - Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois.
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Yang E, Balkhy HH, Patel B, Cotella J, Landeras L, Addetia K, Slivnick JA. Cardiovascular computed tomography for the detection of quadricuspid aortic valve: A case report. Radiol Case Rep 2023; 18:3544-3548. [PMID: 37547798 PMCID: PMC10403715 DOI: 10.1016/j.radcr.2023.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 08/08/2023] Open
Abstract
Aortic regurgitation (AR) represents a significant cause of morbidity and mortality. Due to its low cost and widespread availability, echocardiography remains the frontline for aortic valve (AV) assessment. However, poor sonographic windows may limit the assessment of valve morphology with this technique. Cardiovascular computed tomography (CCT) is increasingly utilized prior to structural AV interventions. Due to its excellent spatial resolution, CCT provides exceptional characterization of aortic leaflets. Accordingly, we present a case of a quadricuspid valve diagnosed by CCT. Here, CCT led to a new diagnosis of quadricuspid valve, highlighting the potential for CCT for the characterization of aortic leaflet morphology. CCT may be particularly useful in patients with contraindications to transesophageal echocardiography or those undergoing structural or robotic interventions.
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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 (Phila) 2023; 18:419-423. [PMID: 37753828 DOI: 10.1177/15569845231199997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Ghandour H, Weiss AJ, Gaudino M, Halkos M, Chu D, Taylor BS, Puskas J, Bhatt DL, Zenati M, Stulak J, Rosengart T, Balkhy HH, Blackstone EH, Svensson LG, Bakaeen FG, Erten O, Karamlou T, Soltesz EG, Gillinov AM, Warmuth A, Roselli EE, Smedira NG. Public reporting for coronary artery bypass graft surgery: The quest for the optimal scorecard. J Thorac Cardiovasc Surg 2023; 166:805-815.e1. [PMID: 35525802 DOI: 10.1016/j.jtcvs.2022.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A number of publicly available rating algorithms are used to assess hospital performance in coronary artery bypass grafting (CABG). However, concerns remain that these algorithms fail to correlate with each other and inadequately capture the case complexity of individual center practices. METHODS Composite star ratings for isolated CABG from the Society of Thoracic Surgeons public reporting database were extracted for 2018-2019. U.S. News & World Report Best Hospitals was used to extract CABG ratings as well as overall cardiology and heart surgery ranking, and the Centers for Medicare & Medicaid Services Hospital Compare was used to extract CABG volume and 30-day mortality. Spearman correlation coefficients were used to assess possible relationships. Expert opinion on risk adjustment and program evaluation was incorporated. RESULTS Correlations between Society of Thoracic Surgeons star rating and U.S. News & World Report overall ranking in cardiology and heart surgery (r = 0.15) and Centers for Medicare & Medicaid Services 30-day mortality (r = -0.27) were poor. Society of Thoracic Surgeons star rating correlated weakly with U.S. News & World Report CABG ratings (r = 0.33) and with Centers for Medicare & Medicaid Services CABG volume (r = 0.32), whereas the latter 2 correlated moderately (r = 0.52) with each other. Of the 75 centers with accredited cardiac surgery training programs, 13 (17%) did not participate in Society of Thoracic Surgeons public reporting. Important gaps were identified in risk assessment, and potential solutions are proposed. CONCLUSIONS Correlations between current CABG public reporting systems are weak. Further work is needed to refine and standardize CABG rating systems to more adequately capture the scope and complexity of an individual center's clinical practice and to better inform patients.
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Affiliation(s)
- Hiba Ghandour
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aaron J Weiss
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York, NY
| | - Michael Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | | | - John Puskas
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass
| | - Marco Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, Mass
| | - John Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Todd Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
| | - Eugene H Blackstone
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Ozgun Erten
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tara Karamlou
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward G Soltesz
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - A Marc Gillinov
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Eric E Roselli
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicholas G Smedira
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Balkhy HH. Commentary: Sternal-sparing coronary artery bypass grafting is here to stay. Time to add robotic technology with multiarterial grafting! J Thorac Cardiovasc Surg 2023:S0022-5223(23)00736-5. [PMID: 37619886 DOI: 10.1016/j.jtcvs.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Husam H Balkhy
- Division of Cardiac Surgery, University of Chicago Medicine, Chicago, Ill.
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10
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Balkhy HH, Grossi EA, Kiaii B, Murphy SME, Kitahara H, Guy TS, Lewis C. Cost and Clinical Outcomes Evaluation Between the Endoaortic Balloon and External Aortic Clamp in Cardiac Surgery. Innovations (Phila) 2023; 18:338-345. [PMID: 37458243 DOI: 10.1177/15569845231185311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Endoaortic balloon occlusion facilitates cardioplegic arrest during minimally invasive surgery (MIS). Studies have shown endoclamping to be as safe as traditional aortic clamping. We compared outcomes and hospital costs of endoclamping versus external aortic occlusion in a large administrative database. METHODS There were 52,882 adults undergoing eligible cardiac surgery (October 2015 to March 2020) identified in the Premier Healthcare Database. Endoclamp procedures (n = 419) were 1:3 propensity score matched to similar procedures using external aortic occlusion (n = 1,244). Generalized linear modeling measured differences in in-hospital complications (major adverse renal and cardiac events, including mortality, new-onset atrial fibrillation, acute kidney injury [AKI], myocardial infarction [MI], postcardiotomy syndrome, stroke/transient ischemic attack [TIA], and aortic dissection) and length of stay (LOS). RESULTS The mean age was 63 years, and 53% were male (n = 882). The majority (93%, n = 1,543) were mitral valve procedures, and 17% of procedures (n = 285) were robot-assisted. Total hospitalization costs were not statistically significantly different between the 2 groups ($52,158 vs $49,839, P = 0.06). The median LOS was significantly shorter in the endoclamp group (incident rate ratio = 0.87, P < 0.001). Mortality, atrial fibrillation, AKI, and stroke/TIA were similar between the 2 groups. MI and postcardiotomy syndrome were lower in the endoclamp group (odds ratio [OR] = 0.14, P = 0.006, and OR = 0.27, P = 0.005). There were no aortic dissections in the endoclamp group. CONCLUSIONS Aortic endoclamping in MIS was associated with similar costs, shorter LOS, no dissections, and comparably low mortality and stroke rates when compared with external clamping in this hospital billing dataset. These results demonstrate the clinical safety and efficacy of endoaortic balloon clamping in a real-world setting. Further studies are warranted.
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Affiliation(s)
| | | | - Bob Kiaii
- University of California Davis Health, Sacramento, CA, USA
| | | | | | - T Sloane Guy
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Clifton Lewis
- University of Alabama School of Medicine, Birmingham, AL, USA
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Watanabe T, Kitahara H, Shah AP, Blair J, Nathan S, Balkhy HH. Sternal-Sparing Surgical Options in Combined Aortic Valve and Coronary Artery Disease: Proof of Concept. Innovations (Phila) 2023; 18:346-351. [PMID: 37458227 DOI: 10.1177/15569845231185566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The standard management of concomitant aortic valve (AV) and coronary artery disease has been coronary artery bypass and AV replacement (AVR). With the advent of minimally invasive options, many isolated lesions have been successfully managed using a sternal-sparing approach. In our institution, patients with isolated AV disease are offered minimally invasive surgical or transcatheter AVR, and those with isolated coronary artery disease are routinely managed with robotic totally endoscopic coronary artery bypass or percutaneous coronary intervention. Various combinations of these techniques can be used when a sternal-sparing posture is desired because of patient risk or preference. The aim of this study was to review the outcomes in patients with combined AV and coronary disease who were managed using sternal-sparing approaches. METHODS We reviewed the records of 10 patients in our minimally invasive surgical database who presented with concomitant AV and coronary artery disease and underwent combined sternal-sparing management of these 2 lesions using various combinations of minimally invasive approaches. RESULTS Four patients had totally endoscopic coronary artery bypass and minimally invasive AVR at the same time, 2 patients underwent transcatheter AVR followed by totally endoscopic coronary artery bypass, and 4 patients underwent minimally invasive AVR with percutaneous coronary intervention. There was no 30-day mortality. The duration of postoperative surgical hospital stay was 3.1 ± 0.9 days. CONCLUSIONS Sternal-sparing approaches in combined AV and coronary artery disease are feasible with patient-specific treatment selection of minimally invasive techniques.
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Affiliation(s)
- Tatsuya Watanabe
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Hiroto Kitahara
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
| | - Atman P Shah
- Division of Cardiology University of Chicago Medicine, IL, USA
| | - John Blair
- Division of Cardiology University of Chicago Medicine, IL, USA
| | - Sandeep Nathan
- Division of Cardiology University of Chicago Medicine, IL, USA
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
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12
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Amabile A, Geirsson A, Krane M, Torregrossa G, Danesi TH, Balkhy HH, Kofidis T. De-Airing Maneuvers After Minimally Invasive and Robotic-Assisted Intracardiac Procedures. Braz J Cardiovasc Surg 2023; 38:407-410. [PMID: 36692050 PMCID: PMC10159075 DOI: 10.21470/1678-9741-2022-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
In the setting of minimally invasive and robotic-assisted intracardiac procedures, de-airing requires further technical considerations due to limited access to the pericardial space and the subsequent difficulty of directly manipulating the heart. We summarize the technical steps for de-airing according to different cannulation strategies for minimally invasive and robotic-assisted intracardiac procedures.
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Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of
Medicine, New Haven, Connecticut, United States of America
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of
Medicine, New Haven, Connecticut, United States of America
| | - Markus Krane
- Division of Cardiac Surgery, Department of Surgery, Yale School of
Medicine, New Haven, Connecticut, United States of America
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute,
Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, United States of
America
| | - Tommaso Hinna Danesi
- Division of Cardiac Surgery, University of Cincinnati College of
Medicine, Cincinnati, Ohio, United States of America
| | - Husam H Balkhy
- Division of Minimally Invasive and Robotic Cardiac Surgery,
Department of Surgery, University of Chicago Medicine, Chicago, Illinois, United
States of America
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
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Algoet M, Oosterlinck W, Balkhy HH. Reply to: Anaortic With No Touch to the Aorta Is a Central Technique to Decrease Invasiveness of CABG. Innovations (Phila) 2023; 18:296. [PMID: 37078616 DOI: 10.1177/15569845231168615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Michiel Algoet
- Department of Cardiovascular Sciences, Research Unit of Cardiac Surgery, KU Leuven, Belgium
| | - Wouter Oosterlinck
- 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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Nisivaco S, Patel B, Coleman C, Kitahara H, Torregrossa G, Balkhy HH. Postoperative Day 1 Discharge After Robotic Totally Endoscopic Coronary Bypass: The Ultimate in Enhanced Recovery After Surgery. Innovations (Phila) 2023; 18:159-166. [PMID: 37029651 DOI: 10.1177/15569845231164374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
OBJECTIVE The benefits of Enhanced Recovery After Surgery (ERAS) protocols are being recognized in multiple surgical specialties, including following coronary bypass surgery to improve quality of care and decrease costs. We developed a fast-track discharge protocol for patients undergoing robotic totally endoscopic coronary bypass surgery (TECAB) to be discharged on postoperative day (POD) 1, the subjects of this study. METHODS In a retrospective study of 720 patients undergoing robotic beating-heart TECAB over 8 years at our institution, 93 patients were selected for a fast-track POD1 discharge protocol. We compared the outcomes of this group to the remaining 627 patients who were discharged per standard protocol (non-POD1 discharge). RESULTS The early discharge group was significantly younger, had lower Society of Thoracic Surgeons (STS) risk of mortality, and had a lower prevalence of obesity, diabetes, and chronic kidney disease. Patients discharged on POD1 were more often extubated in the operating room (56% vs 42%, P = 0.010). The readmission rate for the early discharge group was 3.2%, which was similar to the readmission rate of 6.7% for the standard discharge protocol group (P = 0.329). Time to return to work was shorter in the early discharge group, although it did not quite reach statistical significance (12 vs 18 days, P = 0.051). There was no difference in midterm cardiac mortality. CONCLUSIONS Early discharge on POD1 after robotic TECAB is appropriate in selected patients and is associated with low readmission rates and a trend towards earlier return to work. Patients suitable for this "ultrafast-track" approach were more likely to be younger, have lower STS risk, and fewer comorbidities.
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Affiliation(s)
- Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
| | - Brooke Patel
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
| | - Charocka Coleman
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
| | | | - Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
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15
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Balkhy HH. Achieving Mastery in Robotic-Assisted Coronary Artery Bypass Surgery: Why Stop at One Internal Thoracic Artery Graft!? Ann Thorac Surg 2023; 115:1125-1126. [PMID: 36958513 DOI: 10.1016/j.athoracsur.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Husam H Balkhy
- Division of Cardiac Surgery, University of Chicago Medicine, 5841 S Maryland Avenue, Suite E-500, Chicago, IL 60637.
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Balkhy HH, Grossi EA, Kiaii B, Murphy D, Geirsson A, Guy S, Lewis C. A Retrospective Evaluation of Endo-Aortic Balloon Occlusion Compared to External Clamping in Minimally Invasive Mitral Valve Surgery. Semin Thorac Cardiovasc Surg 2023; 36:27-36. [PMID: 36921680 DOI: 10.1053/j.semtcvs.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 03/16/2023]
Abstract
We compare outcomes of endo-aortic balloon occlusion (EABO) vs external aortic clamping (EAC) in patients undergoing minimally invasive mitral valve surgery (MIMVS) in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. Adults undergoing mitral valve surgery (July 2017-December 2018) were identified within the STS database (N = 60,607). Total 7,978 patients underwent a minimally invasive approach (including robotically assisted). About 1,163 EABO patients were 1:1 propensity-matched to EAC patients using exact matching on age, sex, and type of mitral procedure, and propensity score average matching for 16 other risk indicators. Early outcomes were compared. Categorical variables were compared using logistic regression; hospital and intensive care unit length of stay were compared using negative binomial regression. In the matched cohort, mean age was 62 years; 35.9% were female, and 86% underwent mitral valve repair. Cardiopulmonary bypass time was shorter for EABO vs EAC group (125.0 ± 53.0 vs 134.0 ± 67.0 minutes, P = 0.0009). There was one aortic dissection in the EAC group and none in the EABO group (P value > 0.31), and no statistically significant differences in cross-clamp time, major intraoperative bleeding, perioperative mortality, stroke, new onset of atrial fibrillation, postoperative acute kidney injury, success of repair. Median hospital LOS was shorter for EABO vs EAC procedures (4 vs 5 days, P < 0.0001). In this large, retrospective, STS database propensity-matched analysis ofpatients undergoing MIMVS, we observed similar safety outcomes for EABO and EAC, including no aortic dissections in the EABO group. The EABO group showed slightly shorter CPB times and hospital LOS.
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Affiliation(s)
- Husam H Balkhy
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Eugene A Grossi
- New York University Medical Center, Cardiac Surgery, New York, New York
| | - Bob Kiaii
- Department of Surgery, UC Davis Health, Sacramento, California
| | - Douglas Murphy
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sloane Guy
- Minimally Invasive & Robotic Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Clifton Lewis
- Adult Cardiac Surgery, University of Alabama School of Medicine, Birmingham, Alabama
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Daubenspeck DK, Balkhy HH, Jeevanandam V, Chaney MA. Commentary: You want to do WHAT with my patient?!? J Thorac Cardiovasc Surg 2023; 165:1202-1203. [PMID: 34563369 DOI: 10.1016/j.jtcvs.2021.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Danisa K Daubenspeck
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Ill
| | - Husam H Balkhy
- Robotic and Minimally Invasive Cardiac Surgery, Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Ill
| | - Valluvan Jeevanandam
- Cardiac Surgery, Section of Cardiac Surgery, Department of Surgery, Heart and Vascular Center, University of Chicago Medical Center, Chicago, Ill
| | - Mark A Chaney
- Cardiac Anesthesia, Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Ill.
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Medina F, Estrada A, Allan TE, Balkhy HH, Kim G, Blair JE. MYOCARDIAL BRIDGE IN HEART TRANSPLANT PATIENTS: A RETROSPECTIVE ANALYSIS OF POST-TRANSPLANT INVASIVE CORONARY ARTERY ASSESSMENTS USING CORONARY ANGIOGRAPHY AND INTRAVASCULAR ULTRASOUND. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Badhwar V, Wei LM, Geirsson A, Dearani JA, Grossi EA, Guy TS, Balkhy HH, Gillnov AM, Sutter FP, Melnitchouk S, Bonatti J, Murphy DA, Chitwood WR. Contemporary robotic cardiac surgical training. J Thorac Cardiovasc Surg 2023; 165:779-783. [PMID: 34862051 DOI: 10.1016/j.jtcvs.2021.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/16/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale-New Haven Health System, New Haven, Conn
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, New York University, New York, NY
| | - T Sloane Guy
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Husam H Balkhy
- Division of Cardiac Surgery, University of Chicago, Chicago, Ill
| | - A Marc Gillnov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Francis P Sutter
- Department of Cardiothoracic Surgery, Main Line Health Lankenau Medical Center, Wynnewood, Pa
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Mass
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | | | - W Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
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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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Peev MP, Balkhy HH. Multi-vessel off-pump total endoscopic coronary artery bypass—pearls and pitfalls. J Vis Surg 2023. [DOI: 10.21037/jovs-22-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Peev MP, Kitahara H, Grady K, Balkhy HH. Robotic totally endoscopic mitral valve surgery with moderate hypothermic ventricular fibrillatory arrest. J Vis Surg 2023. [DOI: 10.21037/jovs-22-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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23
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Nisivaco SM, Kitahara H, Abutaleb AR, Nathan S, Balkhy HH. Hybrid Coronary Revascularization: Early Outcomes and Midterm Follow-Up in Patients Undergoing Single or Multivessel Robotic TECAB and PCI. Innovations (Phila) 2022; 17:513-520. [PMID: 36529976 DOI: 10.1177/15569845221137349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Hybrid coronary revascularization (HCR) is the integration of sternal-sparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease (CAD). It is traditionally performed with single-vessel bypass (left internal mammary artery [LIMA] to left anterior descending artery [LAD]) and PCI but can also be accomplished with multiple arterial grafts using bilateral IMA conduits. We sought to review our HCR experience over an 8-year period with robotic totally endoscopic coronary artery bypass (TECAB) and PCI. METHODS Of 694 patients undergoing beating-heart TECAB from August 2013 to June 2022, 306 patients were designated as intention-to-treat HCR candidates. Patients underwent PCI prior to, the same day as, or following TECAB, performed using single or bilateral IMA grafts. We retrospectively reviewed early and midterm outcomes up to 8 years in this cohort of patients. RESULTS The mean Society of Thoracic Surgeons predicted risk of mortality was 1.5% ± 2.5%. There were 44 patients (14%) who had ≥70% left main disease and 218 patients (71%) who had triple-vessel disease. A total of 193 patients (63%) underwent multivessel grafting (advanced HCR), with 83% bilateral IMA use. Mean operative time was 263 ± 80 min, and mean length of stay was 2.6 days. The mean number of vessels bypassed per patient was 1.7 ± 0.6. The mean number of vessels stented was 1.2 ± 0.5. Of the patients, 84% underwent TECAB first, 14% PCI first, and 2% same-day TECAB/PCI. Mortality was 0.6% (observed to expected ratio: 0.42). Early graft patency was 97% (328 of 339 grafts); LIMA-LAD patency was 98%. At 8-year follow-up (mean 37 ± 26 months), all-cause and cardiac-related mortality were 13% and 2.6%, respectively. Freedom from major adverse cardiac and cerebrovascular events was 92%. CONCLUSIONS In patients with multivessel CAD, integrating robotic single and multivessel TECAB with PCI resulted in excellent early and midterm outcomes. In experienced hands, the robotic endoscopic approach allows the routine use of multiple arterial grafting during HCR.
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Affiliation(s)
- Sarah M Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL USA
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL USA
| | | | - Sandeep Nathan
- Department of Cardiology, University of Chicago Medicine, IL USA
| | - Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL USA
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Kitahara H, Balkhy HH. Minimally invasive mitral valve surgery with or without robotics: Examining the evidence. J Card Surg 2022; 37:3276-3278. [PMID: 35989500 PMCID: PMC9543420 DOI: 10.1111/jocs.16854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
Minimally invasive mitral valve surgery can be performed with or without robotic assistance. In this issue of the journal, Zheng et al. compare between these two approaches in a propensity‐matched study over a 5‐year period and show that the two techniques have similar successful short and mid‐term outcomes. Although we are proponents of the robotic approach, we agree with their conclusions and discuss in this commentary some of the previously published studies that have shown similar findings.
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Affiliation(s)
- Hiroto Kitahara
- Department of Surgery, Section of Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Husam H Balkhy
- Department of Surgery, Section of Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois, USA
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Srivastava A, Smazil J, Roark L, Shah HA, Balkhy HH, Shah AP. Transcatheter aortic valve replacement in patients undergoing robotic totally endoscopic coronary artery bypass: A case series. Front Cardiovasc Med 2022; 9:988029. [PMID: 36172589 PMCID: PMC9510675 DOI: 10.3389/fcvm.2022.988029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has been utilized to treat patients with symptomatic aortic stenosis (AS). Recent trials suggest comparable efficacy compared to surgical aortic valve replacement (SAVR). Robotic off-pump totally endoscopic coronary artery bypass graft surgery (TECAB) had been shown to be a minimally invasive revascularization strategy with clinical results comparable to traditional coronary artery bypass graft surgery (CABG). Traditionally, pre-surgical coronary evaluation is considered necessary to optimize coronary revascularization at the time of AVR. The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Disease gives a moderate recommendation, based on limited data, for CABG at the time of AVR in patients with significant coronary artery disease (CAD). This paper presents two patients with known significant CAD awaiting robotic TECAB who were treated with TAVR, prior to surgical revascularization. Robotic TECAB is unique in that it offers patients the ability to have complete coronary revascularization without a sternotomy and with early ambulation, discharge, and recovery. The case series demonstrates a hybrid approach that offers complete sternotomy sparing cardiovascular care to treat severe symptomatic AS and CAD. Since patients with severe aortic stenosis are at high risk of developing cardiac arrest and cardiogenic shock upon induction of anesthesia, the ability to treat severe symptomatic AS with TAVR under conscious sedation prior to TECAB can be considered as a safe an effective treatment.
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Affiliation(s)
- Ankur Srivastava
- Section of Cardiology, University of Chicago Medicine, Chicago, IL, United States
- *Correspondence: Ankur Srivastava
| | - Jennifer Smazil
- Section of Cardiology, University of Chicago Medicine, Chicago, IL, United States
| | - Lauren Roark
- Section of Cardiology, University of Chicago Medicine, Chicago, IL, United States
| | - Hayla A. Shah
- University of Chicago Laboratory Schools, Chicago, IL, United States
| | - Husam H. Balkhy
- Section of Cardiac Surgery, University of Chicago Medicine, Chicago, IL, United States
| | - Atman P. Shah
- Section of Cardiology, University of Chicago Medicine, Chicago, IL, United States
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Balkhy HH, Nisivaco S, Kitahara H, AbuTaleb A, Nathan S, Hamzat I. Robotic advanced hybrid coronary revascularization: Outcomes with two internal thoracic artery grafts and stents. JTCVS Tech 2022; 16:76-88. [PMID: 36510526 PMCID: PMC9735326 DOI: 10.1016/j.xjtc.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Advanced hybrid coronary revascularization is the integration of sternal-sparing multivessel coronary artery bypass grafting and percutaneous coronary intervention in patients with multivessel coronary artery disease. We sought to review our advanced hybrid coronary revascularization experience over an 8.5-year period using robotic totally endoscopic coronary artery bypass with bilateral internal thoracic artery grafts and percutaneous coronary intervention. Methods From August 2013 to February 2022, 664 patients underwent robotic totally endoscopic coronary artery bypass at our institution. Of the 293 patients who underwent totally endoscopic coronary artery bypass assigned to a hybrid revascularization strategy, 156 patients received bilateral internal thoracic artery grafts and are the subject of this review. Patients underwent percutaneous coronary intervention with drug-eluting stents before or after totally endoscopic coronary artery bypass. We reviewed early and midterm outcomes (up to 8 years) in this cohort of patients with intent-to-treat advanced hybrid coronary revascularization. Results The mean age of patients was 65 ± 10 years. The mean Society of Thoracic Surgeons predicted risk of mortality was 1.26 ± 1.56. Triple-vessel disease occurred in 94% of patients, and 17% of patients had 70% or more left-main disease. The mean operative time was 311 ± 54 minutes, and the mean hospital length of stay was 2.7 ± 1.1 days. All patients had bilateral internal thoracic artery grafts; the total number of grafts was 334. Eight seven percentage of patients had totally endoscopic coronary artery bypass ×2, and 13% of patients had totally endoscopic coronary artery bypass ×3. One patient received totally endoscopic coronary artery bypass ×4. The mean number of grafts per patient was 2.14 ± 0.4, and the mean number of vessels stented was 1.23 ± 0.5. There were no conversions, perioperative stroke, or myocardial infarction. Early mortality occurred in 2 patients. Early graft patency was 98% (209/214 grafts); left internal thoracic artery to left anterior descending patency was 100% (66/66 grafts). At 8-year follow-up in 155 patients (mean 39 ± 26 months), all-cause and cardiac-related mortality were 11.6% and 3.9%, respectively. Freedom from major adverse cardiac/cerebrovascular events including repeat revascularization was 94%. Conclusions In patients with multivessel coronary artery disease, integrating robotic totally endoscopic coronary artery bypass with bilateral internal thoracic artery and percutaneous coronary intervention resulted in excellent early and midterm outcomes. Further studies are warranted.
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Key Words
- AHCR, advanced hybrid coronary revascularization
- BITA, bilateral internal thoracic artery
- BMI, body mass index
- CABG, coronary artery bypass grafting
- CAD, coronary artery disease
- DAPT, dual-antiplatelet therapy
- HCR, hybrid coronary revascularization
- LAD, left anterior descending artery
- LITA, left internal thoracic artery
- LOS, length of stay
- MACCE, major adverse cardiac/cerebrovascular events
- MAG, multi-arterial grafting
- MI, myocardial infarction
- MIDCAB, minimally invasive direct coronary artery bypass
- PCI, percutaneous coronary intervention
- RCA, right coronary artery
- RITA, right internal thoracic artery
- SITA, single internal thoracic artery
- TECAB
- TECAB, totally endoscopic coronary artery bypass
- bilateral internal thoracic arteries
- coronary artery bypass
- hybrid revascularization
- off-pump
- percutaneous coronary intervention
- robotic
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Affiliation(s)
- Husam H. Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Ill,Address for reprints: Husam H. Balkhy, MD, Department Cardiothoracic Surgery, University of Chicago, 5841 S. Maryland Ave, E-500, Chicago, IL 60637.
| | - Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Ill
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Ill
| | | | - Sandeep Nathan
- Department of Cardiology, University of Chicago Medicine, Chicago, Ill
| | - Ibraheem Hamzat
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Ill
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Nisivaco SM, Balkhy HH. Sparing Not Only the Sternum but also the Pain: Why Port-Only is Best. Eur J Cardiothorac Surg 2022; 62:6633310. [PMID: 35799363 DOI: 10.1093/ejcts/ezac382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
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Freiling TP, Dhawan R, Balkhy HH, Castillo J, Cotter EK, Chaney MA. MYOCARDIAL BRIDGE: DIAGNOSIS, TREATMENT, AND CHALLENGES. J Cardiothorac Vasc Anesth 2022; 36:3955-3963. [DOI: 10.1053/j.jvca.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/11/2022]
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Yang B, Nisivaco S, Torregrossa G, Balkhy HH. Transit Time Flow Measurement in Robotic Totally Endoscopic Coronary Artery Bypass: What Do the Numbers Mean? Innovations�(Phila) 2022; 17:136-141. [DOI: 10.1177/15569845221091515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Transit time flow measurement (TTFM) is valuable for assessing intraoperative graft patency in coronary artery bypass surgery (CAB). The significance of competitive native coronary flow on patency, as predicted by percentage of backflow (%BF) on TTFM, is unknown. This study aims to evaluate intraoperative TTFM parameters, and specifically %BF, in predicting graft patency in robotic totally endoscopic CAB (TECAB). Methods We reviewed TTFM parameters in 311 patients undergoing robotic off-pump TECAB at our institution between February 2016 and January 2020. Patients with sequential or Y grafts were excluded, leaving 277 patients with a total of 387 isolated end-to-side grafts (248 left internal mammary artery [LIMA], 149 right IMA [RIMA]). Mean graft flow, diastolic flow, pulsatility index, and %BF were measured intraoperatively. Early postoperative angiograms were obtained in 83 patients undergoing percutaneous coronary intervention for hybrid revascularization, with a total of 125 grafts. Angiograms were independently analyzed and separated into 2 groups based on IMA graft patency, which were patent (FitzGibbon A/B) and nonpatent (FitzGibbon O) groups. Results Early angiographic patency at a median of 31.0 days after surgery showed 123 (97.1%) patent grafts and 3 (2.9%) occluded grafts in both LIMA and RIMA grafts to both left anterior descending (LAD) and non-LAD targets. Mean graft flow was 77.4 ± 41.6 mL/min. There was no difference in mean flow, pulsatility index, or %BF between the patent and occluded grafts. Conclusions Excellent intraoperative flow parameters and early angiographic patency can be obtained via robotic, off-pump TECAB. Our data did not demonstrate an association between intraoperative TTFM evidence of competitive native coronary flow and early angiographic graft outcomes.
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Affiliation(s)
- Benjamin Yang
- Robotic and Minimally Invasive Cardiac Surgery, University of Chicago, IL, USA
| | - Sarah Nisivaco
- Robotic and Minimally Invasive Cardiac Surgery, University of Chicago, IL, USA
| | | | - Husam H. Balkhy
- Robotic and Minimally Invasive Cardiac Surgery, University of Chicago, IL, USA
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Peev MP, Nisivaco S, Torregrossa G, Arastu A, Shahul S, Balkhy HH. Robotic Off-Pump Totally Endoscopic Coronary Artery Bypass in Patients With Low Ejection Fraction. Innovations (Phila) 2022; 17:50-55. [PMID: 35225062 DOI: 10.1177/15569845211073929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Robotic totally endoscopic coronary bypass (R-TECAB) has been shown to be a safe and effective technique with excellent outcomes. The aim of this study is to assess the feasibility of R-TECAB in patients with low left ventricular ejection fraction (LVEF) and to report our midterm outcomes with up to 7-year follow-up. Methods: All patients undergoing R-TECAB at our institution between July 2013 and July 2020 were retrospectively reviewed. A total of 100 patients were identified with low LVEF defined as ≤40%. The preoperative characteristics, perioperative and postoperative outcomes, as well as the midterm results were reviewed. Results: The mean LVEF was 31%, and 62% of all patients had preexisting congestive heart failure. Of the cohort, 59% had 3-vessel disease and 6% underwent previous cardiac surgery. Multivessel TECAB was performed in 54%. Hybrid coronary revascularization occurred in 36 individuals. Two patients required cardiopulmonary bypass, and 35% were extubated in the operating room. No sternotomy conversions were required. One patient underwent reoperation for bleeding. No perioperative stroke, myocardial infarction, or mortality occurred. The left internal mammary artery graft patency was 97% at a mean of 1.6 months in the staged hybrid percutaneous coronary intervention group. At midterm follow-up the cardiac-related mortality was 5%. Heart transplant or left ventricular assist device was required in 4 patients, and 1 patient experienced a myocardial infarction. Freedom from major adverse cardiac events was 89%. Conclusions: Off-pump TECAB can be successfully performed in patients with low LVEF in the setting of an experienced and dedicated robotic cardiac surgery team. Our data demonstrate the feasibility of the technique with excellent perioperative and midterm outcomes.
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Affiliation(s)
- Miroslav P Peev
- Department of Surgery, Section of Cardiac Surgery, 12246University of Chicago, IL, USA
| | | | - Gianluca Torregrossa
- Department of Surgery, Section of Cardiac Surgery, 12246University of Chicago, IL, USA
| | | | - Sajid Shahul
- Department of Anesthesia, University of Chicago, IL, USA
| | - Husam H Balkhy
- Department of Surgery, Section of Cardiac Surgery, 12246University of Chicago, IL, USA
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Balkhy HH, Nisivaco SM, Hashimoto M, Torregrossa G, Grady K. Robotic Total Endoscopic Coronary Bypass in 570 Patients: Impact of Anastomotic Technique in 2 Eras. Ann Thorac Surg 2021; 114:476-482. [PMID: 34890572 DOI: 10.1016/j.athoracsur.2021.10.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND In coronary bypass grafting, including robotic off-pump totally-endoscopic coronary bypass (TECAB), the anastomotic technique is the most critical part of the procedure. We reviewed results in 570 patients over a 7-year period and compared outcomes between to eras, based on predominant anastomotic technique: connectors versus running suture. METHODS Between 7/2013-12/2020, 570 patients underwent off-pump TECAB. Group-1 (378 patients, 7/2013-8/2018) using predominantly the C-Port Flex ATM distal anastomotic stapler (Aesculap, Tuttlingen Germany), Group-2 (192 patients, 9/2018-12/2020) using predominantly a sutured technique (7-0 PronovaTM, Johnson and Johnson, USA). Retrospective analysis of clinical outcomes was performed. RESULTS Off-pump TECAB was completed in 98.8% (563/570 patients) with an Observed/Expected mortality of 0.6 (6/570 patients). The anastomotic device was used in 89% of 626 grafts in Group-1 and only 11% of 305 grafts in Group-2 (p=0.001). There were no differences in multivessel TECAB (57%vs.53%;p=0.331) or bilateral internal thoracic artery use (50%vs.43%;p=0.127) in Group-1 vs Group-2, respectively. Operative time was shorter in Group-1 (242+84 min vs. 273+88 min;p<0.001). Early clinical outcomes were similar between groups, except for hospital stay which was longer in Group-1 (2.9vs2.3 days;p<0.001). Graft patency was similar (98%vs95%;p=0.295) in Group-1 vs Group-2, respectively. CONCLUSIONS Changing the predominant approach from stapled anastomosis to a sutured technique during robotic TECAB resulted in longer operative times. Both approaches led to excellent outcomes, including graft patency. The shorter operative times conferred by using staplers may flatten the learning curve and facilitate broader adoption of TECAB.
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Affiliation(s)
- Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois.
| | - Sarah M Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Makoto Hashimoto
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kaitlin Grady
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
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Balkhy HH. Robotic totally endoscopic coronary artery bypass grafting: It's now or never! JTCVS Tech 2021; 10:153-157. [PMID: 34977718 PMCID: PMC8690331 DOI: 10.1016/j.xjtc.2021.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Husam H. Balkhy
- Address for reprints: Husam H. Balkhy, MD, FACS, FACC, Section of Cardiac Surgery, University of Chicago, 5841 S Maryland Ave, E-500, Chicago, IL 60637.
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Brownlee AR, Amabile A, Torregrossa G, Balkhy HH. Robotic totally endoscopic triple bypass with bilateral internal mammary arteries and two different anastomotic techniques. J Card Surg 2021; 37:249-251. [PMID: 34747050 DOI: 10.1111/jocs.16112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022]
Abstract
Robotic totally endoscopic coronary artery bypass (TECAB) offers several advantages over conventional sternotomy coronary artery bypass grafting. TECAB allows the increased use of bilateral internal mammary artery grafts independent of gender, body mass index or diabetes, minimizes the risk of wound infection, decreases the length of hospital stay, and improves the postoperative quality of life. Off-pump beating heart TECAB has been used to offer one or two grafts generally on the anterior wall. We describe our approach to perform beating heart, triple-vessel TECAB with targets on the lateral and posterolateral wall of the left ventricle.
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Affiliation(s)
- Andrew R Brownlee
- Division of Thoracic Surgery, Cedars Sinai, Los Angeles, California, USA.,Division of Minimally Invasive and Robotic Cardiac Surgery, The University of Chicago, Chicago, Illinois, USA
| | - Andrea Amabile
- Division of Minimally Invasive and Robotic Cardiac Surgery, The University of Chicago, Chicago, Illinois, USA.,Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gianluca Torregrossa
- Division of Minimally Invasive and Robotic Cardiac Surgery, The University of Chicago, Chicago, Illinois, USA
| | - Husam H Balkhy
- Division of Minimally Invasive and Robotic Cardiac Surgery, The University of Chicago, Chicago, Illinois, USA
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Abstract
Minimally invasive direct coronary artery bypass grafting (MIDCAB) and totally endoscopic coronary artery bypass grafting (TECAB) are the two existing strategies for robotic-assisted, surgical myocardial revascularization. In this review, we summarize the wide evidence available in the literature regarding the benefits of these two procedures, and detail the technical skills required to master robotic coronary surgery techniques.
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Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA -
| | - Gianluca Torregrossa
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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35
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Van den Eynde J, Vaesen Bentein H, Decaluwé T, De Praetere H, Wertan MC, Sutter FP, Balkhy HH, Oosterlinck W. Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis. J Thorac Dis 2021; 13:4260-4270. [PMID: 34422354 PMCID: PMC8339757 DOI: 10.21037/jtd-21-775] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/11/2021] [Indexed: 12/07/2022]
Abstract
Background Learning curves are inevitably encountered when first implementing an innovative and complex surgical technique. Nevertheless, a cluster of failures or complications should be detected early, but not deter learning, to ensure safe implementation. Here, we aimed to examine the presence and impact of learning curves on outcome after robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB). Methods A retrospective analysis of the first 300 RA-MIDCAB surgeries between July 2015 and December 2020 was performed. Learning curves were obtained via logarithmic regression for surgical time. Cumulative sum (CUSUM) analysis was performed for (I) major complications including MI, stroke, repeat revascularization, and mortality, and (II) other complications, including prolonged ventilation, pneumonia, pleura puncture, lung herniation, pericarditis, pleuritis, arrhythmia, wound complications, and delirium. Expected and unacceptable rates were set at 12% and 20%, respectively, for major complications, and at 40% and 60% for other complications, based on historical data in conventional coronary artery bypass grafting (CABG). Results Demographic characteristics did not differ between terciles, except for more smokers in the first tercile, and less hypercholesterolemia and more complex procedures in the third tercile. The mean surgical time for all operations was 258±81 minutes, ranging from 127 to 821 minutes. A learning curve was only observed in the first tercile. Subgroup analysis revealed that this learning curve was only observed for procedures consisting of single internal mammary artery (SIMA) with 1 or 2 distal anastomoses but not with bilateral internal mammary arteries (BIMA) or more than 2 distal anastomoses. CUSUM analysis showed that the cumulative rate of major and other complications never crossed the lines for unacceptable rates. Rather, the lower 95% confidence boundary was crossed after 50 cases, indicating improvement in safety. Conclusions These results suggest that integration of RA-MIDCAB in the surgical landscape can be safely achieved and complication rates can quickly be reduced below those expected in traditional CABG. Collective experience plays a key role in overcoming the learning curve when more complex procedures and cases are introduced.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Hannah Vaesen Bentein
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Tom Decaluwé
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Herbert De Praetere
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - MaryAnn C Wertan
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Francis P Sutter
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Wouter Oosterlinck
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Balkhy HH, Nisivaco S, Kitahara H, Torregrossa G, Patel B, Grady K, Coleman C. Robotic off-pump totally endoscopic coronary artery bypass in the current era: report of 544 patients. Eur J Cardiothorac Surg 2021; 61:439-446. [PMID: 34392341 DOI: 10.1093/ejcts/ezab378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/27/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Robotic off-pump totally endoscopic coronary artery bypass (TECAB) is the least invasive form of surgical coronary revascularization. It has proved to be highly effective and safe. Its benefits are well-established and include fewer complications, shorter hospital stay and quicker return to normal activities. TECAB has undergone 2 decades of technological advancement to include multivessel grafting, a beating-heart approach and successful completion in multiple patient groups in experienced hands. The aim of this report was to examine outcomes of robotic off-pump TECAB at our institution over 7 years. METHODS Data from 544 patients undergoing TECAB between July 2013 and August 2020 were retrospectively examined. The C-Port Flex-A distal anastomotic device was used for the majority of grafts (70%). Yearly follow-up was conducted. Angiographic early patency data were reviewed for patients undergoing hybrid revascularization. RESULTS The mean age was 66 years, with 1.7% mean STS risk. Fifty-six percentage had multivessel TECAB. There was 1 conversion to sternotomy, and 46% extubation in the Operating Room (OR). Mortality was 0.9%. Early graft patency was 97%. At mid-term follow-up at 38 months, cardiac mortality was 2.7% and freedom from major adverse cardiac events was 92.5%. CONCLUSIONS We conclude that robotic beating-heart TECAB in the current era is safe and effective with excellent outcomes and comparable early angiographic patency to standard coronary artery bypass grafting surgery when performed frequently by an experienced team. This procedure was completed in our hands both with and without an anastomotic device. Longer-term studies are warranted.
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Affiliation(s)
- Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Brooke Patel
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kaitlin Grady
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Charocka Coleman
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
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Torregrossa G, Amabile A, Oosterlinck W, Van den Eynde J, Mori M, Geirsson A, Balkhy HH. The epicenter of change: Robotic cardiac surgery as a career choice. J Card Surg 2021; 36:3497-3500. [PMID: 34351025 DOI: 10.1111/jocs.15865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Gianluca Torregrossa
- Department of Surgery, Division of Minimally Invasive and Robotic Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Andrea Amabile
- Department of Surgery, Yale School of Medicine, Division of Cardiac Surgery, New Haven, Connecticut, USA
| | - Wouter Oosterlinck
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Makoto Mori
- Department of Surgery, Yale School of Medicine, Division of Cardiac Surgery, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Department of Surgery, Yale School of Medicine, Division of Cardiac Surgery, New Haven, Connecticut, USA
| | - Husam H Balkhy
- Department of Surgery, Division of Minimally Invasive and Robotic Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois, USA
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38
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Luc JGY, Ad N, Nguyen TC, Arora RC, Balkhy HH, Bender EM, Bethencourt DM, Bisleri G, Boyd D, Chu MWA, de la Cruz KI, DeAnda A, Engelman DT, Farkas EA, Fedoruk LM, Fiocco M, Forcillo J, Fradet G, Fremes SE, Gammie JS, Geirsson A, Gerdisch MW, Girard LN, Kaiser CA, Kaneko T, Kent WDT, Khabbaz KR, Khoynezhad A, Kiaii B, Lee R, Legare JF, Lehr EJ, MacArthur RGG, McCarthy PM, Mehall JR, Merrill WH, Moon MR, Ouzounian M, Peltz M, Perrault LP, Preventza O, Ramchandani M, Ramlawi B, Salenger R, Sekela ME, Sellke FW, Stulak JM, Sutter FP, Timek TA, Whitman G, Williams JB, Wong DR, Yanagawa B, Ye J, Zeigler SM. Cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic. J Card Surg 2021; 36:3040-3051. [PMID: 34118080 PMCID: PMC8447333 DOI: 10.1111/jocs.15681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 01/31/2023]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID‐19 pandemic. Methods A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed. Results Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID‐19, they were most worried with exposing their family to COVID‐19 (81%), followed by contracting COVID‐19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID‐19 burden, with higher COVID‐19 burden institutions more likely to resort to PPE conservation strategies. Conclusions The present study demonstrates the impact of COVID‐19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Niv Ad
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Adventist White Oak Medical Center, Silver Spring, Maryland, USA
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas, USA
| | | | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Illinois, USA
| | - Edward M Bender
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California, USA
| | - Daniel M Bethencourt
- Division of Cardiac Surgery, Orange Coast Memorial Medical Centers, Fountain Valley, California, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Douglas Boyd
- Division of Cardiothoracic Surgery, East Carolina University, Brody School of Medicine, Greenville, North Carolina, USA
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Kim I de la Cruz
- Division of Cardiothoracic Surgery, Methodist Heart Hospital San Antonio, San Antonio, Texas, USA
| | - Abe DeAnda
- Division of Cardiovascular and Thoracic Surgery, UTMB-Galveston, Galveston, Texas, USA
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, Springfield, Massachusetts, USA
| | - Emily A Farkas
- Division of Cardiac Surgery, ThedaCare Appleton Heart Institute, Appleton, Wisconsin, USA
| | - Lynn M Fedoruk
- Division of Cardiac Surgery, Royal Jubilee Hospital, Vancouver Island Health Authority, University of British Columbia, Victoria, British Columbia, Canada
| | - Michael Fiocco
- Division of Cardiac Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Jessica Forcillo
- Division of Cardiac Surgery, Université de Montréal, Department of Cardiac Surgery- Montréal University Hospital Centre (CHUM), Montreal, Quebec, Canada
| | - Guy Fradet
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Stephen E Fremes
- Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Gammie
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Arnar Geirsson
- Department of Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc W Gerdisch
- Department of Cardiothoracic Surgery, Franciscan Health Heart Center, Indianapolis, IN, USA
| | - Leonard N Girard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Clayton A Kaiser
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William D T Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Khoynezhad
- Department of Cardiovascular Surgery, Memorial Heart and Vascular Institute, Memorial Care Long Beach Medical Center, Long Beach, California, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Richard Lee
- Division of Cardiothoracic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jean-Francois Legare
- Division of Cardiac Surgery, New Brunswick Heart Center, Dalhousie University, Saint John, New Brunswick, Canada
| | - Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, Seattle, Washington, USA
| | - Roderick G G MacArthur
- Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - John R Mehall
- Division of Cardiac Surgery, Penrose-St Francis Health Services, Colorado Springs, Colorado, USA
| | - Walter H Merrill
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Louis P Perrault
- Division of Cardiac Surgery, Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - Ourania Preventza
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mahesh Ramchandani
- Department of Cardiothoracic Surgery, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Valley Health System - Heart and Vascular Center, Winchester Medical Center, Winchester, VA, USA
| | - Rawn Salenger
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael E Sekela
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis P Sutter
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judson B Williams
- Department of Cardiovascular and Thoracic Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Daniel R Wong
- Division of Cardiac Surgery, Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jian Ye
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sanford M Zeigler
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Van Praet KM, Kofler M, Shafti TZN, El Al AA, van Kampen A, Amabile A, Torregrossa G, Kempfert J, Falk V, Balkhy HH, Jacobs S. Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature. ACTA ACUST UNITED AC 2021; 16:e08. [PMID: 34295373 PMCID: PMC8287382 DOI: 10.15420/icr.2021.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/29/2021] [Indexed: 12/21/2022]
Abstract
Minimally invasive coronary revascularisation was originally developed in the mid 1990s as minimally invasive direct coronary artery bypass (MIDCAB) grafting is a less invasive approach compared to conventional coronary artery bypass grafting (CABG) to address targets in the left anterior descending coronary artery (LAD). Since then, MIDCAB has evolved with the adoption of a robotic platform and the possibility to perform multivessel bypass procedures. Minimally invasive coronary revascularisation surgery also allows for a combination between the benefits of CABG and percutaneous coronary interventions for non-LAD lesions – a hybrid approach. Hybrid coronary revascularisation results in fewer blood transfusions, shorter hospital stay, decreased ventilation times and patients return to work sooner when compared to conventional CABG. This article reviews the available literature, describes standard approaches and considers topics, such as limited access procedures, indications and patient selection, diagnostics and imaging, techniques, anastomotic devices, hybrid coronary revascularisation and outcome analysis.
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Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| | - Timo Z Nazari Shafti
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Berlin Institute of Health Berlin, Germany
| | - Alaa Abd El Al
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| | - Antonia van Kampen
- ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Leipzig Heart Center, University Clinic for Cardiac Surgery Leipzig, Germany
| | - Andrea Amabile
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Gianluca Torregrossa
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Berlin Institute of Health Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin Berlin, Germany.,Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zurich, Switzerland
| | - Husam H Balkhy
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
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40
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Viox D, Dhawan R, Balkhy HH, Cormican D, Bhatt H, Savadjian A, Chaney MA. Unilateral Pulmonary Edema After Robotically Assisted Mitral Valve Repair Requiring Veno-Venous Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2021; 36:321-331. [PMID: 33975792 DOI: 10.1053/j.jvca.2021.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 01/17/2023]
Abstract
Unilateral pulmonary edema (UPE) is an uncommon yet potentially life-threatening complication of minimally invasive cardiac surgery (MICS). Most frequently described after robotically assisted mitral valve (MV) repair, it is characterized by right lung edema, hypoxemia, hypercapnia, pulmonary hypertension, and hemodynamic instability beginning minutes-to-hours after separation from cardiopulmonary bypass (CPB). The authors describe a severe case with refractory hypoxemia requiring veno-venous (VV) extracorporeal membrane oxygenation (ECMO) after robotically assisted MV repair.
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Affiliation(s)
- Dan Viox
- Department of Anesthesiology, Emory University Hospital, Atlanta, GA
| | - Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Husam H Balkhy
- Robotic and Minimally Invasive Cardiac Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Daniel Cormican
- Cardiothoracic Anesthesiology, Allegheny General Hospital, Surgical Critical Care Medicine, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Himani Bhatt
- Division of Cardiac Anesthesiology, Mount Sinai Morningside Medical Center, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andre Savadjian
- Division of Cardiac Anesthesiology, Mount Sinai Morningside Medical Center, New York, NY
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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41
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Torregrossa G, Amabile A, Fonceva A, Hosseinian L, Williams EE, Balkhy HH, Ramakrishna H. Outcomes in Complete Arterial Coronary Revascularization. J Cardiothorac Vasc Anesth 2020; 34:3444-3448. [DOI: 10.1053/j.jvca.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 11/11/2022]
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Abstract
In developing countries, limited resources and low health budgets result in slow developments in the field of cardiac surgery. As a consequence, advances in surgery become a challenging process. In Colombia, most institutions do not have the capacity or infrastructure for minimally invasive and video-assisted cardiac surgery, let alone robotic assisted cardiac surgery (RACS). Despite the challenges, efforts to overcome these hurdles are critical for the future of cardiac surgery in low-income settings. Here we describe the first cases of robotic cardiac surgeries performed in Colombia.
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Affiliation(s)
- Darío Andrade
- Department of Cardiac Surgery, Fundacion Clinica Shaio, Bogotá, Colombia
| | - Eric E Vinck
- Department of Cardiac Surgery, Fundacion Clinica Shaio, Bogotá, Colombia
| | - Juan F Parra
- Department of Cardiac Surgery, Fundacion Clinica Shaio, Bogotá, Colombia
| | - Husam H Balkhy
- Department of Cardiac Surgery, University of Chicago Medicine, Chicago, Illinois, United States
| | - Federico Núñez
- Department of Cardiac Surgery, Fundacion Clinica Shaio, Bogotá, Colombia
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Balkhy HH, Nathan S, Torregrossa G, Kitahara H, Nisivaco S, McCrorey M, Patel B. Angiographic patency after robotic beating heart totally endoscopic coronary artery bypass grafting facilitated by automated distal anastomotic connectors. Interact Cardiovasc Thorac Surg 2020; 31:467-474. [PMID: 33091933 DOI: 10.1093/icvts/ivaa149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/17/2020] [Accepted: 07/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Robotic totally endoscopic coronary artery bypass (TECAB) on the beating heart has been facilitated in our experience using distal coronary anastomotic connectors. In this study, we retrospectively reviewed graft patency in all robotic TECAB patients who underwent formal angiography at our current institution over a 5-year period. METHODS Between July 2013 and June 2018, 361 consecutive patients underwent robotic beating-heart TECAB. Of these patients, 121 had a follow-up angiogram, which assessed graft patency. Eighty-four patients had an angiogram as part of planned hybrid procedures and 37 patients underwent an unplanned angiogram for clinical indications. Retrospective analysis of angiographic patency and clinical outcomes was performed. RESULTS The mean Society of Thoracic Surgeons predicted risk of mortality was 1.8%. Single-vessel bypass was performed in 40 (33%) patients and multivessel grafting in 81 (67%). Average flow (ml/min) and pulsatility index in the grafts was 74.7 ± 39.1 and 1.42 ± 0.52, respectively. The number of grafts evaluated was 204 (130 left internal mammary artery and 74 right internal mammary artery grafts). The median time to angiography was 1.0 and 16.0 months and graft patency was 98% and 91% in the hybrid and non-hybrid groups, respectively. Overall graft patency was 95.6% (left internal mammary artery = 96%; right internal mammary artery = 93%). Left internal mammary artery to left anterior descending artery graft patency was 97%. Clinical follow-up was available for 316 (88%) patients at mean 22.5 ± 15.1 months. Freedom from major adverse cardiac events at 2 years was 92%. CONCLUSIONS In this consecutive series of patients undergoing formal angiography after robotic single and multivessel TECAB, we found satisfactory graft patency and 2-year clinical outcomes. Longer-term follow-up is warranted.
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Affiliation(s)
- Husam H Balkhy
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Sandeep Nathan
- Division of Cardiology, Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Gianluca Torregrossa
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Hiroto Kitahara
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Sarah Nisivaco
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Mackenzie McCrorey
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Brooke Patel
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
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Balkhy HH, Nisivaco S, Tung A, Torregrossa G, Mehta S. Does Intolerance of Single-Lung Ventilation Preclude Robotic Off-Pump Totally Endoscopic Coronary Bypass Surgery? Innovations�(Phila) 2020; 15:456-462. [DOI: 10.1177/1556984520940462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Robotic off-pump totally endoscopic coronary artery bypass (TECAB) usually requires isolated single (right) lung ventilation to adequately expose the surgical site. However, in some patients, persistent oxygen desaturation may occur and conversion to cardiopulmonary bypass (CPB) or sternotomy may be necessary. We reviewed the characteristics and clinical outcomes in patients who did not tolerate single-lung ventilation during TECAB surgery. Methods After Institutional Review Board approval we reviewed 440 patients undergoing robotic TECAB at our institution between July 2013 and April 2019. Patients were separated into 2 groups based on their ability to tolerate single-lung ventilation during the procedure. Group 1 included patients able to tolerate single-lung ventilation and Group 2 were patients who required double-lung ventilation to tolerate the procedure. Early and mid-term outcomes were compared. Results Group 2 (121 patients) had higher Society of Thoracic Surgeons scores, higher body mass index, and more triple-vessel disease than Group 1 (319 patients). Group 2 had more bilateral internal mammary artery use, multivessel grafting, and longer operative times. One patient underwent conversion to sternotomy and 5 required CPB (all in Group 1). Intensive care unit and hospital length of stay were longer in Group 2. Observed/expected mortality did not differ between groups (1.06% in Group 2 vs 0.4% in Group 1; P = 0.215). At mid-term follow-up, cardiac-related/overall mortality and freedom from major adverse cardiac events were similar. Conclusions In our cohort, intolerance of single-lung ventilation did not preclude robotic off-pump TECAB. Double-lung ventilation is feasible during the procedure and may prevent conversions to sternotomy or use of CPB, resulting in excellent early and mid-term outcomes.
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Affiliation(s)
- Husam H. Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
| | - Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA
| | - Avery Tung
- Department of Anesthesia, University of Chicago Medicine, IL, USA
| | | | - Sachin Mehta
- Department of Anesthesia, University of Chicago Medicine, IL, USA
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Mirzai S, Yang B, Mitzman B, Torregrossa G, Balkhy HH. Robotic Repair of Adult Left-Sided Partial Anomalous Pulmonary Venous Connection. Ann Thorac Surg 2020; 111:e77-e79. [PMID: 32693036 DOI: 10.1016/j.athoracsur.2020.05.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
Abstract
Isolated anomalous drainage of the left pulmonary vein to the left innominate vein is a rare variant of partial anomalous pulmonary venous connection. Here, we describe 2 adult patients with this variant who underwent successful robotic totally endoscopic repair with anastomosis of the pulmonary vein to the left atrial appendage.
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Affiliation(s)
- Saeid Mirzai
- Alabama College of Osteopathic Medicine, Dothan, Alabama.
| | - Benjamin Yang
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Brian Mitzman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Gianluca Torregrossa
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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Mirzai S, Saleh S, Balkhy HH, Shah AP, Jeevanandam V, Blair JEA. Urgent Open Atrial Transcatheter Mitral Valve Replacement as Bailout for Planned Surgery. JACC Case Rep 2020; 2:1115-1119. [PMID: 34317429 PMCID: PMC8311715 DOI: 10.1016/j.jaccas.2020.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 11/07/2022]
Abstract
Hybrid transcatheter mitral valve replacement (TMVR) has shown great promise for patients with severe mitral annular calcification. However, there have been limited reports of its use as a bailout for planned surgical MVR. Here, we present a bailout TMVR with an excellent patient outcome. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Saeid Mirzai
- Alabama College of Osteopathic Medicine, Dothan, Alabama
| | - Saleh Saleh
- Jordan University of Science and Technology, Irbid, Jordan
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Atman P Shah
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Valluvan Jeevanandam
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - John E A Blair
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
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Rosati CM, Torregrossa G, Balkhy HH, Puskas JD. Dedicated training in advanced coronary surgery: Need and opportunity. J Thorac Cardiovasc Surg 2020; 161:2130-2134. [PMID: 32482407 DOI: 10.1016/j.jtcvs.2020.03.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Gianluca Torregrossa
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY
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Balkhy HH, Kitahara H, Hirai T, Matsukage H, Nathan S. Residual SYNTAX Score After Advanced Hybrid Robotic Totally Endoscopic Coronary Revascularization. Ann Thorac Surg 2020; 109:1826-1832. [DOI: 10.1016/j.athoracsur.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/18/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
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Torregrossa G, Amabile A, Balkhy HH. Totally robotic sutured coronary artery bypass grafting: How we do it. JTCVS Tech 2020; 3:170-172. [PMID: 34317858 PMCID: PMC8302941 DOI: 10.1016/j.xjtc.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gianluca Torregrossa
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Andrea Amabile
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
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Affiliation(s)
- Timothy M. Guenther
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
- Department of Surgery, David Grant USAF Medical Center, Fairfield, CA, USA
| | - Sarah A. Chen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Husam H. Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
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