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Totally Endoscopic Coronary Artery Bypass Graft: Systematic Review and Meta-Analysis of Reconstructed Patient-Level Data. 完全内窥镜冠状动脉旁路移植术:重建患者层面数据的系统性回顾和 Meta 分析。
IF 1.6 Q2 SURGERY Pub Date : 2024-11-20 DOI: 10.1177/15569845241296530
Ioannis Zoupas, Vasiliki Manaki, Panagiotis T Tasoudis, Nina-Rafailia Karela, Dimitrios V Avgerinos, Konstantinos S Mylonas

Objective: The standard approach for coronary artery bypass grafting is open surgery. Totally endoscopic coronary artery bypass has emerged as an alternative for selected patients. This meta-analysis sought to evaluate clinical outcomes with this emerging technique.

Methods: A PRISMA-compliant search was performed up to December 14, 2022, in PubMed (MEDLINE), Scopus, and Cochrane. Time-to-event data were reconstructed using Kaplan-Meier curves from source literature.

Results: A total of 2,774 patients with symptomatic coronary artery disease underwent totally endoscopic coronary artery bypass in 18 eligible studies. The mean patient age was 63.2 ± 12.3 years, and 77.5% (95% confidence interval [CI]: 72.2% to 82.4%) of the included patients were males. The mean operative time was 304.2 ± 155 min, whereas the mean internal mammary artery takedown time was 38.3 ± 18.4 min. Of the patients, 4.7% (95% CI: 1.6% to 9.1%) required conversions to open surgery. The 30-day complication rate was 5.9% (95% CI: 1.2% to 13.1%), whereas late complications developed in 4.8% (95% CI: 1.9% to 8.5%) of the patients. Freedom from major adverse cardiac events was 93.4% (95% CI: 85.3% to 94.8%) and 1-year, 5-year, and 10-year survival rates were 95.2%, 83.2%, and 81.7%, respectively. Reintervention was required in 3.3% (95% CI: 2.3% to 4.4%) of the cohort within a mean follow-up of 42.5 ± 27.8 months.

Conclusions: Totally endoscopic coronary artery bypass may be a safe and viable alternative for selected patients with coronary artery disease. Long-term follow-up will help define the place of robotic endoscopic treatment in the armamentarium of myocardial revascularization.

目的:冠状动脉搭桥术的标准方法是开放手术。完全内窥镜冠状动脉搭桥术已成为特定患者的一种选择。这项荟萃分析旨在评估这种新兴技术的临床效果:截至 2022 年 12 月 14 日,在 PubMed (MEDLINE)、Scopus 和 Cochrane 中进行了符合 PRISMA 标准的检索。结果:共有 2,774 名患者接受了治疗:在18项符合条件的研究中,共有2774名无症状冠状动脉疾病患者接受了全内镜冠状动脉搭桥术。患者平均年龄为 63.2 ± 12.3 岁,77.5%(95% 置信区间 [CI]:72.2% 至 82.4%)的患者为男性。平均手术时间为(304.2 ± 155)分钟,而平均切除乳内动脉的时间为(38.3 ± 18.4)分钟。患者中有 4.7%(95% CI:1.6% 至 9.1%)需要转为开放手术。30天并发症发生率为5.9%(95% CI:1.2%至13.1%),4.8%(95% CI:1.9%至8.5%)的患者出现晚期并发症。重大心脏不良事件发生率为93.4%(95% CI:85.3%至94.8%),1年、5年和10年生存率分别为95.2%、83.2%和81.7%。在平均 42.5 ± 27.8 个月的随访期间,3.3%(95% CI:2.3% 至 4.4%)的患者需要再次介入治疗:结论:对于选定的冠状动脉疾病患者来说,完全内窥镜冠状动脉搭桥术可能是一种安全可行的替代方案。长期随访将有助于确定机器人内窥镜治疗在心肌血管再通术中的地位。
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引用次数: 0
The 10 Commandments for State-of-the-Art Imaging of the Proximal Thoracic Aorta. 胸主动脉近端最新成像十诫》。
IF 1.6 Q2 SURGERY Pub Date : 2024-11-18 DOI: 10.1177/15569845241297993
Marko T Boskovski, Elaine E Tseng
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引用次数: 0
Robot-Assisted Atrial Septal Defect Closure Via the Left Atrium: Dual Case Reports. 机器人辅助经左心房关闭房室隔缺损:双病例报告。
IF 1.6 Q2 SURGERY Pub Date : 2024-11-12 DOI: 10.1177/15569845241296083
Yazan N AlJamal, Hiroto Kitahara, Husam H Balkhy
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引用次数: 0
Tricuspid Anterior and Posterior Patch (TRAPP) Repair of Functional Tricuspid Regurgitation. 三尖瓣前后补片(TRAPP)修复功能性三尖瓣反流。
IF 1.6 Q2 SURGERY Pub Date : 2024-11-08 DOI: 10.1177/15569845241287772
Hannah J Rando, Rachael W Quinn, Zachary Darby, Emily L Larson, Emily Rodriguez, Jin Kook Kang, Ifeanyi Chinedozi, James S Gammie

Objective: Annuloplasty is the most common strategy for repair of functional tricuspid regurgitation (FTR) but is not effective in patients with massive/torrential FTR or leaflet tethering. To address the deficits of tricuspid annuloplasty, TRicuspid Anterior and Posterior Patch (TRAPP) repair was developed, which is a pericardial patch augmentation of the anterior and posterior leaflets.

Methods: To test this repair, a previously validated ex vivo model in an explanted porcine heart was used, wherein annular and leaflet geometry were evaluated using a 3-dimensional structured light scanner at 4 time points: (1) baseline, (2) induction of FTR, (3) annuloplasty repair, and (4) patch repair.

Results: Compared with the regurgitant tricuspid valve, annuloplasty reduced annular circumference (13.7 to 9.5 cm) and area (13.7 vs 6.1 cm2), whereas TRAPP repair did not alter annular dimensions (circumference: 13.7 vs 13.5 cm; area: 13.7 vs 13.6 cm2). Annuloplasty increased leaflet tenting angles (anterior: 53.5° vs 41.0°; posterior: 59.7° vs 48.2°; septal: 38.9° vs 31.4°) whereas TRAPP repair relieved anterior and posterior leaflet tenting (anterior: 28.9° vs 41.0°; posterior: 34.9° vs 48.2°; septal: 33.2° vs 31.4°) and restored geometry comparable to the native tricuspid valve. Central coaptation lengths were greater with TRAPP repair than with annuloplasty for all 3 leaflets (anterior: 12.7 vs 9.5 mm; posterior: 12.2 vs 8.2 mm; septal: 7.4 vs 4.6 mm).

Conclusions: Compared with annuloplasty, TRAPP repair yielded greater coaptation length, resolved leaflet tethering, and resulted in a larger annular area that may facilitate durable repair of advanced FTR, which previously would have required replacement.

目的:瓣环成形术是修复功能性三尖瓣反流(FTR)最常用的方法,但对大面积/侵入性 FTR 或瓣叶拴住的患者无效。为了解决三尖瓣瓣环成形术的缺陷,开发了三尖瓣前后补片(TRAPP)修复术,即心包补片增强前后瓣叶:为了测试这种修补方法,我们使用了之前验证过的猪心体外模型,在 4 个时间点使用三维结构光扫描仪评估了瓣环和瓣叶的几何形状:(1)基线;(2)诱导 FTR;(3)瓣环成形术修补;(4)补片修补:结果:与反流性三尖瓣相比,瓣环成形术缩小了瓣环周长(13.7 至 9.5 厘米)和面积(13.7 vs 6.1 平方厘米),而 TRAPP 修复术没有改变瓣环尺寸(周长:13.7 vs 13.5 厘米;面积:13.7 vs 13.6 平方厘米)。瓣环成形术增加了瓣叶折角(前:53.5° vs 41.0°;后:59.7° vs 48.2°;室间隔:38.9° vs 31.4°),而 TRAPP 修复术缓解了前后瓣叶折角(前:28.9° vs 41.0°;后:34.9° vs 48.2°;室间隔:33.2° vs 31.4°),并恢复了与原生三尖瓣相似的几何形状。与瓣环成形术相比,TRAPP修复术后所有3个瓣叶的中心瓣合长度都更大(前瓣:12.7 mm vs 9.5 mm;后瓣:12.2 mm vs 8.2 mm;隔瓣:7.4 mm vs 4.6 mm):与瓣环成形术相比,TRAPP修复术可获得更大的合流长度,解决了瓣叶系带问题,并可获得更大的瓣环面积,这可能有助于晚期FTR的持久修复,而在此之前则需要进行置换。
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引用次数: 0
The 10 Commandments of Endo-Bentall Repair. 内科-本托尔维修十诫。
IF 1.6 Q2 SURGERY Pub Date : 2024-11-08 DOI: 10.1177/15569845241288837
Mehrdad Ghoreishi, Shahab Toursavadkohi
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引用次数: 0
Innovative Surgical Left Atrial Appendage Closure Technique: Early Experience of Inverted Spiral Closure Technique. 创新的左房阑尾闭合手术技术:倒置螺旋闭合技术的早期经验。
IF 1.6 Q2 SURGERY Pub Date : 2024-11-08 DOI: 10.1177/15569845241288564
Eiki Nagaoka, Hirokuni Arai, Tomohiro Mizuno, Keiji Oi, Tatsuki Fujiwara, Kiyotoshi Oishi, Tomoyuki Fujita

Objective: Simultaneous closure of the left atrial appendage (LAA) during cardiac procedures has become a common preventive measure against cardiogenic embolic events associated with atrial fibrillation. However, this strategy encounters limitations during minimally invasive mitral valve surgery through a right minithoracotomy because access to the LAA is limited. The use of endocardial sutures for surgical exclusion of the LAA is also well established but has a notable rate of closure failure. We introduced a new surgical LAA closure technique called the inverted spiral closure technique (ISCT).

Methods: Between July 2020 and August 2021, 26 patients underwent LAA closure with ISCT concomitant to mitral valve surgery in our hospital. Early postoperative outcomes and any stroke or thromboembolic event during the follow-up were evaluated. Transthoracic or transesophageal echocardiography (TEE) was used to assess LAA patency.

Results: The ISCT procedure was performed successfully in all cases. No significant persistent flow between the left atrium and LAA was observed on intraoperative TEE. During a median follow-up of 1.1 years, no patients experienced stroke, myocardial infarction, or death. Postoperative echocardiography showed no significant residual flow within the LAA. One patient was incidentally found to have recanalization between the left atrium and LAA several months after surgery on an enhanced computed tomography scan during coronary evaluation.

Conclusions: The ISCT can be performed reliably through the same left atriotomy for mitral valve surgery and is a useful and effective technique for surgical LAA exclusion. There are still not enough patients and modalities for postoperative evaluation.

目的:在心脏手术过程中同时关闭左心房附壁(LAA)已成为预防与心房颤动相关的心源性栓塞事件的常见措施。然而,在通过右侧小胸腔切口进行微创二尖瓣手术时,由于进入 LAA 的通道有限,这一策略受到了限制。使用心内膜缝线进行 LAA 手术切除的方法也已得到广泛认可,但其关闭失败率较高。我们引入了一种新的手术 LAA 封闭技术,称为倒置螺旋封闭技术(ISCT):方法:2020 年 7 月至 2021 年 8 月期间,我院有 26 名患者在接受二尖瓣手术的同时接受了 ISCT LAA 关闭术。方法:2020年7月至2021年8月期间,我院有26名患者在接受二尖瓣手术的同时进行了LAA关闭术,评估了术后早期疗效以及随访期间的中风或血栓栓塞事件。经胸或经食道超声心动图(TEE)用于评估LAA的通畅情况:结果:所有病例均成功实施了ISCT手术。术中 TEE 未观察到左心房和 LAA 之间有明显的持续血流。在中位 1.1 年的随访期间,没有患者发生中风、心肌梗死或死亡。术后超声心动图显示 LAA 内无明显残余血流。一名患者在术后数月进行冠状动脉评估时,偶然在增强计算机断层扫描中发现左心房和 LAA 之间有再通:ISCT可以通过与二尖瓣手术相同的左心房切开术可靠地进行,是一种有用且有效的手术LAA排除技术。目前仍没有足够的患者和方法进行术后评估。
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引用次数: 0
The 10 Commandments for the Ross Procedure. 罗斯程序十诫。
IF 1.6 Q2 SURGERY Pub Date : 2024-11-01 DOI: 10.1177/15569845241294051
Nader S Aboelnazar, Katie Losenno, Lin-Rui Guo, Michael W A Chu
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引用次数: 0
Minimally Invasive Video-Assisted Surgery for Concomitant Ascending Aorta and Aortic Valve Replacement via Right Infra-Axillary Thoracotomy. 通过右腋下胸廓切开术进行升主动脉和主动脉瓣同时置换的微创视频辅助手术
IF 1.6 Q2 SURGERY Pub Date : 2024-11-01 DOI: 10.1177/15569845241285872
Shuwei Wang, Chentao Luo, Bing Zhou, Zhibin Hu, Zhifang Liu, Erlei Han, Changhao Wu, Fuyang Mei, Xiaofeng Lu, Weikang Chen, Zhiqiang Dong, Yong Cui

Objective: This study aims to assess the safety, efficacy, and esthetic outcomes of an innovative 4 cm right infra-axillary incision approach for concomitant ascending aorta and aortic valve replacement (AAR and AVR), with a specific focus on achieving optimal surgical outcomes while ensuring minimal visible scarring.

Methods: We retrospectively examined all elective cases of concomitant AAR and AVR surgery performed at our institution from July 2021 to June 2023. Exclusions encompassed emergency surgery, acute type A aortic dissection, active aortic valve endocarditis, redo cardiac surgery, the necessity for concurrent mitral valve replacement, or left ventricular assist device implantation. We collected and analyzed perioperative data for the patients.

Results: The study comprised 24 consecutive patients. Cardiopulmonary bypass time and aortic cross-clamp time averaged 215.0 (interquartile range [IQR], 38.0) and 158.0 (IQR, 37.0) min, respectively. No instances of reoperation due to postoperative bleeding or need for permanent pacemaker implantation were recorded. Initial 24-h postoperative drainage volume averaged 186.9 ± 76.9 mL. Average follow-up duration was 21.7 ± 6.2 months (range, 5 to 30 months). Throughout short-term follow-up, no occurrences of valve dysfunction, paravalvular leak, cardiovascular events necessitating readmission, or mortality were observed.

Conclusions: The right infra-axillary incision approach effectively yields secure, successful, and cosmetically pleasing outcomes for concomitant AAR and AVR. Further research and comparisons are warranted to validate these findings.

研究目的本研究旨在评估一种创新的右侧腋下 4 厘米切口方法用于同时进行升主动脉和主动脉瓣置换术(AAR 和 AVR)的安全性、有效性和美学效果,重点是在确保最小可见瘢痕的同时实现最佳手术效果:我们回顾性地检查了 2021 年 7 月至 2023 年 6 月期间在我院进行的所有同期升主动脉瓣和主动脉瓣置换术的择期手术病例。不包括急诊手术、急性 A 型主动脉夹层、活动性主动脉瓣心内膜炎、重做心脏手术、必须同时进行二尖瓣置换术或左室辅助装置植入术。我们收集并分析了患者的围手术期数据:研究共包括 24 名连续患者。心肺旁路时间和主动脉交叉钳夹时间分别平均为 215.0 分钟(四分位距[IQR],38.0)和 158.0 分钟(四分位距[IQR],37.0)。没有因术后出血或需要植入永久起搏器而再次手术的记录。术后 24 小时初始引流量平均为 186.9 ± 76.9 mL。平均随访时间为 21.7 ± 6.2 个月(5 至 30 个月)。在整个短期随访过程中,没有观察到瓣膜功能障碍、瓣膜旁漏、需要再次入院的心血管事件或死亡:结论:右腋下切口方法能有效地为同时进行的 AAR 和 AVR 带来安全、成功和美观的结果。有必要进行进一步的研究和比较,以验证这些发现。
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引用次数: 0
Results of Vertical Infra-Axillary Thoracotomy for Total Repair of Tetralogy of Fallot. 垂直腋下胸廓切开术完全修复法洛氏四联症的结果
IF 1.6 Q2 SURGERY Pub Date : 2024-11-01 DOI: 10.1177/15569845241278985
Tien Anh Do, Bao Tuan Luong, Tran Thuy Nguyen, Phong Ba Nguyen, Huyen Nhu Thi Luong, Viet Bang Nguyen, Minh Ngoc Le, Duong Ha Thai Nguyen, Thanh Ngoc Le

Objective: To demonstrate the efficacy of minimally invasive surgery via a vertical infra-axillary incision for complete tetralogy of Fallot (TOF) correction.

Methods: In a study conducted from April to October 2023, 33 patients with TOF underwent total repair using this approach. On average, the patient age was 5.94 ± 2.68 months, weight was 6.49 ± 0.97 kg, and mean z-score index for the pulmonary valve annulus was -1.38 ± 0.92. Results also highlighted abnormal coronary artery pathways in 18.2% of cases, including 1 patient with dextrocardia and situs inversus.

Results: The average incision length was 4.01 ± 0.6 cm, with bypass and clamping times of 95.42 ± 33.19 min and 69.24 ± 28.15 min, respectively. Preservation of the pulmonary valve annulus was achieved in 67% of patients. No postoperative deaths occurred, and there were no significant ventilation differences between groups. After surgery, no severe pulmonary valve regurgitation was observed, with patients remaining in excellent condition throughout the 7-month follow-up. The pulmonary valve pressure gradient after the procedure was 23.97 ± 10.65 mm Hg, and no heart failure cases were reported per the Ross classification at the latest follow-up.

Conclusions: The vertical infra-axillary incision approach for total TOF repair is safe, effective, and cosmetically advantageous.

目的证明通过腋下垂直切口进行微创手术完全矫正法洛氏四联症(TOF)的疗效:在 2023 年 4 月至 10 月进行的一项研究中,33 名 TOF 患者采用这种方法接受了全修复手术。患者平均年龄为(5.94±2.68)个月,体重为(6.49±0.97)千克,肺动脉瓣环的平均 Z 评分指数为(-1.38±0.92)。结果还显示,18.2%的病例存在冠状动脉路径异常,其中包括1名患有右心室突出和坐位不正的患者:平均切口长度为(4.01 ± 0.6)厘米,分流和夹闭时间分别为(95.42 ± 33.19)分钟和(69.24 ± 28.15)分钟。67%的患者保留了肺动脉瓣环。术后无死亡病例,组间通气量无明显差异。术后未观察到严重的肺动脉瓣反流,患者在7个月的随访中状况良好。术后肺动脉瓣压力梯度为(23.97 ± 10.65)毫米汞柱,在最近的随访中,根据罗斯分类法,没有出现心力衰竭病例:结论:腋下垂直切口全 TOF 修补术安全、有效,且具有美观优势。
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引用次数: 0
Coronary Connector Facilitated Total Endoscopic Coronary Artery Bypass: An Ex Vivo Feasibility Study. 冠状动脉连接器辅助全内镜冠状动脉搭桥术:一项体内外可行性研究。
IF 1.6 Q2 SURGERY Pub Date : 2024-10-29 DOI: 10.1177/15569845241288540
Monica Gianoli, Anne Roos de Jong, Harmen Matthijs Wassink, Paul F Gründeman, Bob Kiaii, Husam H Balkhy, Willem J L Suyker

Objective: Totally endoscopic coronary artery bypass (TECAB) procedures pose significant challenges, motivating the development of Octocon, an automated endoscopic connector designed for coronary anastomoses in off-pump and endoscopic settings. This feasibility study aimed to assess Octocon's functionality and maneuverability in closed-chest conditions during robot-assisted TECAB simulations.

Methods: The Octocon deployment comprises a 3-step procedure. Initially, delicate self-aligning microstapling technology is used to attach connector halves to individual blood vessels. Subsequently, the connector halves are joined to accomplish the anastomosis process. TECAB conditions were simulated using a dedicated box housing ex vivo porcine hearts. The study, conducted by 3 experienced surgeons, investigated the feasibility and standardization potential of a robot-assisted procedure employing Octocon. It evaluated maneuverability in closed-chest conditions and assessed the effectiveness of grafting internal mammary artery segments to different heart regions using single graft, jump graft, and Y-graft constructions.

Results: The robot-assisted procedure, using 4 standard instruments, successfully completed all 3 steps in 18 anastomotic procedures. In 96% of cases, the procedural steps were accomplished on the first attempt. The feasibility of constructing jump graft and Y-graft geometries on both anterior and posterior heart walls was demonstrated. Furthermore, experiences affirmed the device's endoscopic user-friendliness, ease of teachability, reproducibility, and potential to achieve expedient, leak-free anastomoses.

Conclusions: This ex vivo study confirmed Octocon's potential suitability and functionality for TECAB. The device can create diverse grafting strategies and achieve wide-open vascular connections on various heart regions, highlighting its potential in advancing minimally invasive, robot-assisted coronary procedures. These promising results justify further exploration for integration into clinical practice.

目的:全内镜冠状动脉搭桥术(TECAB)带来了巨大的挑战,促使 Octocon 的开发,Octocon 是一种自动内镜连接器,设计用于非泵和内镜环境下的冠状动脉吻合。这项可行性研究旨在评估 Octocon 在机器人辅助 TECAB 模拟中闭合胸腔条件下的功能性和可操作性:Octocon 部署包括 3 个步骤。方法:Octocon 的部署包括 3 个步骤。首先,使用精密的自对准微缝技术将连接器的两半连接到单个血管上。随后,连接两半连接器,完成吻合过程。TECAB 条件是使用一个容纳体外猪心的专用箱进行模拟的。这项研究由 3 位经验丰富的外科医生进行,调查了采用 Octocon 的机器人辅助手术的可行性和标准化潜力。该研究评估了闭胸条件下的可操作性,并评估了使用单一移植、跳跃移植和 Y 型移植结构将乳内动脉段移植到不同心脏区域的有效性:结果:机器人辅助手术使用 4 种标准器械,成功完成了 18 例吻合手术的所有 3 个步骤。96%的病例在第一次尝试时就完成了手术步骤。在心脏前壁和后壁上构建跳跃移植物和 Y 形移植物的可行性得到了证实。此外,经验还证实了该装置的内窥镜用户友好性、易学性、可重复性以及实现快速无漏吻合的潜力:这项体内外研究证实了 Octocon 对 TECAB 的潜在适用性和功能性。该设备可以创建多种移植策略,并在不同心脏区域实现开放式血管连接,突出了其在推进微创、机器人辅助冠状动脉手术方面的潜力。这些令人鼓舞的结果证明,有理由进一步探索将其融入临床实践的可能性。
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引用次数: 0
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Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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