Pub Date : 2024-11-01DOI: 10.1177/15569845241294051
Nader S Aboelnazar, Katie Losenno, Lin-Rui Guo, Michael W A Chu
{"title":"The 10 Commandments for the Ross Procedure.","authors":"Nader S Aboelnazar, Katie Losenno, Lin-Rui Guo, Michael W A Chu","doi":"10.1177/15569845241294051","DOIUrl":"https://doi.org/10.1177/15569845241294051","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Minimally Invasive Video-Assisted Surgery for Concomitant Ascending Aorta and Aortic Valve Replacement via Right Infra-Axillary Thoracotomy.","authors":"Shuwei Wang, Chentao Luo, Bing Zhou, Zhibin Hu, Zhifang Liu, Erlei Han, Changhao Wu, Fuyang Mei, Xiaofeng Lu, Weikang Chen, Zhiqiang Dong, Yong Cui","doi":"10.1177/15569845241285872","DOIUrl":"https://doi.org/10.1177/15569845241285872","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 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.
{"title":"Results of Vertical Infra-Axillary Thoracotomy for Total Repair of Tetralogy of Fallot.","authors":"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","doi":"10.1177/15569845241278985","DOIUrl":"https://doi.org/10.1177/15569845241278985","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the efficacy of minimally invasive surgery via a vertical infra-axillary incision for complete tetralogy of Fallot (TOF) correction.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>The vertical infra-axillary incision approach for total TOF repair is safe, effective, and cosmetically advantageous.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 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.
{"title":"Coronary Connector Facilitated Total Endoscopic Coronary Artery Bypass: An Ex Vivo Feasibility Study.","authors":"Monica Gianoli, Anne Roos de Jong, Harmen Matthijs Wassink, Paul F Gründeman, Bob Kiaii, Husam H Balkhy, Willem J L Suyker","doi":"10.1177/15569845241288540","DOIUrl":"https://doi.org/10.1177/15569845241288540","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1177/15569845241289429
Vito D Bruno, Bleri Celmeta, Tommaso Viva, Arturo Bisogno, Antonio Miceli, Mattia Glauber
Objective: Minimally invasive surgery determines shorter postoperative hospital length of stay (LOS) even in cardiac surgery. Potential preoperative factors affecting LOS are still not known in minimally invasive heart valve surgery (MIVS). We aimed to identify preoperative variables influencing prolonged LOS in MIVS.
Methods: We reviewed 189 patients who underwent MIVS via minithoracotomy at our institution. Prolonged LOS was defined as more than 7 postoperative days. Poisson and logistic regression were used to screen the predictors.
Results: The mean postoperative LOS was 9.13 days, and 64 patients (33.9%) experienced a prolonged LOS. These patients were older, more frequently in New York Heart Association (NYHA) class III or IV, showed worse left ventricular ejection function (LVEF), and had a higher incidence of reoperation and chronic kidney disease (CKD). At univariate analysis, the most significant preoperative factors affecting prolonged LOS were age (odds ratio [OR] = 1.04), NYHA class III or IV (OR = 3.03), reduced LVEF (OR = 3.22), CKD (OR = 2.7), and redo surgery (OR = 3.6). After adjustment, the most significant preoperative factors predicting prolonged LOS were age (OR = 1.03, 95% CI: 1.01 to 1.06, P = 0.02) and redo surgery (OR = 3.33, 95% CI: 1.29 to 8.9, P = 0.01).
Conclusions: The most important factors affecting prolonged LOS after MIVS were represented by age and redo surgery, although other preoperative characteristics such as reduced LVEF, NYHA class III or IV, and CKD play a significant role in delaying recovery after MIVS. Further larger studies are needed to better identify potential preoperative predictors of prolonged LOS after MIVS.
目的:即使在心脏外科手术中,微创手术也能缩短术后住院时间(LOS)。在微创心脏瓣膜手术(MIVS)中,影响住院时间的潜在术前因素尚不清楚。我们旨在确定影响微创心脏瓣膜手术住院时间延长的术前变量:我们回顾了在本院通过小切口进行微创心脏瓣膜手术的 189 例患者。LOS 延长定义为术后超过 7 天。采用泊松和逻辑回归筛选预测因素:术后平均住院时间为 9.13 天,64 名患者(33.9%)的住院时间延长。这些患者年龄较大,多为纽约心脏病协会(NYHA)Ⅲ级或Ⅳ级患者,左心室射血功能(LVEF)较差,再次手术和慢性肾病(CKD)的发生率较高。在单变量分析中,术前对延长 LOS 影响最大的因素是年龄(比值比 [OR] = 1.04)、NYHA III 级或 IV 级(OR = 3.03)、左心室射血功能降低(OR = 3.22)、慢性肾脏病(OR = 2.7)和再次手术(OR = 3.6)。经调整后,预测LOS延长的最重要术前因素是年龄(OR = 1.03,95% CI:1.01至1.06,P = 0.02)和再次手术(OR = 3.33,95% CI:1.29至8.9,P = 0.01):影响 MIVS 术后 LOS 延长的最重要因素是年龄和再次手术,尽管其他术前特征,如 LVEF 降低、NYHA III 级或 IV 级和 CKD 在延迟 MIVS 术后恢复方面也起着重要作用。需要进一步开展更大规模的研究,以更好地确定术前预测 MIVS 术后 LOS 延长的潜在因素。
{"title":"A Risk Prediction Model for Prolonged Length of Stay After Minimally Invasive Valve Surgery.","authors":"Vito D Bruno, Bleri Celmeta, Tommaso Viva, Arturo Bisogno, Antonio Miceli, Mattia Glauber","doi":"10.1177/15569845241289429","DOIUrl":"https://doi.org/10.1177/15569845241289429","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive surgery determines shorter postoperative hospital length of stay (LOS) even in cardiac surgery. Potential preoperative factors affecting LOS are still not known in minimally invasive heart valve surgery (MIVS). We aimed to identify preoperative variables influencing prolonged LOS in MIVS.</p><p><strong>Methods: </strong>We reviewed 189 patients who underwent MIVS via minithoracotomy at our institution. Prolonged LOS was defined as more than 7 postoperative days. Poisson and logistic regression were used to screen the predictors.</p><p><strong>Results: </strong>The mean postoperative LOS was 9.13 days, and 64 patients (33.9%) experienced a prolonged LOS. These patients were older, more frequently in New York Heart Association (NYHA) class III or IV, showed worse left ventricular ejection function (LVEF), and had a higher incidence of reoperation and chronic kidney disease (CKD). At univariate analysis, the most significant preoperative factors affecting prolonged LOS were age (odds ratio [OR] = 1.04), NYHA class III or IV (OR = 3.03), reduced LVEF (OR = 3.22), CKD (OR = 2.7), and redo surgery (OR = 3.6). After adjustment, the most significant preoperative factors predicting prolonged LOS were age (OR = 1.03, 95% CI: 1.01 to 1.06, <i>P</i> = 0.02) and redo surgery (OR = 3.33, 95% CI: 1.29 to 8.9, <i>P</i> = 0.01).</p><p><strong>Conclusions: </strong>The most important factors affecting prolonged LOS after MIVS were represented by age and redo surgery, although other preoperative characteristics such as reduced LVEF, NYHA class III or IV, and CKD play a significant role in delaying recovery after MIVS. Further larger studies are needed to better identify potential preoperative predictors of prolonged LOS after MIVS.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Safe Training Method for ITA Harvesting via Median Sternotomy in Minimally Invasive Coronary Artery Bypass Surgery Using Harmonic Scalpel.","authors":"Keita Kikuchi, Kunihiko Yoshino, Hiroki Sakai, Yoshun Sai, Kaito Masuda, Joji Ito","doi":"10.1177/15569845241290240","DOIUrl":"https://doi.org/10.1177/15569845241290240","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1177/15569845241286012
Syed Faaz Ashraf, Laura Seese, Irsa S Hasan, Ashok N Babu, Husam H Balkhy, Bob B Kiaii, T Sloane Guy, David J Kaczorowski, Johannes Bonatti
Objective: We created and validated a low-cost simulation model for robotic internal mammary artery (IMA) takedown.
Methods: The simulation model utilized a calf fetus thorax cavity stented open internally and secured to a table. The simulation model was validated at a 2-day robotic cardiac surgery workshop. Each participant harvested one IMA using the da Vinci Xi robot (Intuitive Surgical, Sunnyvale, CA, USA). We compared participant self-reported confidence at robotic IMA harvest before and after using the simulator.
Results: Our novel thorax-securing strategy resulted in a stable structure and allowed access to both IMAs from the same 3 ports. The cost to set up the first simulation model was $176 and $133 for every subsequent model. Fifty participants used the simulation model: 42 cardiothoracic surgery attendings and 8 fellows or residents. The feedback form response rate was 78% (n = 39). On the Likert scale, participants rated realism of the calf model to simulate robotic IMA harvesting (0 = not realistic, 10 = highly realistic) with a median of 8 out of 10 (interquartile range [IQR] 7 to 9). Participant confidence (0 = not at all confident, 10 = very confident) in robotic IMA harvesting before and after using the simulator increased (P = 0.001) from a median of 5 (IQR 1 to 7) to 9 (IQR 7 to 10).
Conclusions: This robotic IMA harvest simulation model is affordable, realistic, and improved participant confidence in robotic IMA harvest. It may provide a valuable training tool for surgeons learning robotic coronary bypass surgery and allows for training frequency necessary to pass basic learning curves.
目的我们创建并验证了一种低成本的机器人乳内动脉(IMA)剥离模拟模型:方法:模拟模型利用小牛胎儿胸腔内部支架打开并固定在手术台上。模拟模型在为期两天的机器人心脏手术研讨会上进行了验证。每位参与者使用达芬奇Xi机器人(直觉外科,美国加利福尼亚州桑尼维尔市)摘除一个IMA。我们比较了参与者在使用模拟器前后自我报告的机器人 IMA 切除信心:结果:我们新颖的胸腔固定策略带来了稳定的结构,并允许从相同的 3 个端口进入两个 IMA。建立第一个模拟模型的费用为 176 美元,之后每个模型的费用为 133 美元。50 名参与者使用了该模拟模型:42 名心胸外科主治医师和 8 名研究员或住院医师。反馈表回复率为 78%(n = 39)。在李克特量表上,参与者对模拟机器人 IMA 切除的小腿模型的逼真度进行了评分(0 = 不逼真,10 = 非常逼真),中位数为 8 分(10 分满分)(四分位数间距 [IQR] 7 到 9)。使用模拟器前后,参与者对机器人 IMA 切除术的信心(0 = 完全没有信心,10 = 非常有信心)从中位数 5(IQR 1 到 7)增加到 9(IQR 7 到 10)(P = 0.001):该机器人 IMA 切除模拟模型经济实惠、逼真,提高了参与者对机器人 IMA 切除的信心。它可为学习机器人冠状动脉搭桥手术的外科医生提供有价值的培训工具,并允许通过基本学习曲线所需的培训频率。
{"title":"Development and Validation of a Low-Cost, High-Fidelity Simulation Model for Robotic Internal Mammary Artery Harvest Using the da Vinci Xi Robot.","authors":"Syed Faaz Ashraf, Laura Seese, Irsa S Hasan, Ashok N Babu, Husam H Balkhy, Bob B Kiaii, T Sloane Guy, David J Kaczorowski, Johannes Bonatti","doi":"10.1177/15569845241286012","DOIUrl":"https://doi.org/10.1177/15569845241286012","url":null,"abstract":"<p><strong>Objective: </strong>We created and validated a low-cost simulation model for robotic internal mammary artery (IMA) takedown.</p><p><strong>Methods: </strong>The simulation model utilized a calf fetus thorax cavity stented open internally and secured to a table. The simulation model was validated at a 2-day robotic cardiac surgery workshop. Each participant harvested one IMA using the da Vinci Xi robot (Intuitive Surgical, Sunnyvale, CA, USA). We compared participant self-reported confidence at robotic IMA harvest before and after using the simulator.</p><p><strong>Results: </strong>Our novel thorax-securing strategy resulted in a stable structure and allowed access to both IMAs from the same 3 ports. The cost to set up the first simulation model was $176 and $133 for every subsequent model. Fifty participants used the simulation model: 42 cardiothoracic surgery attendings and 8 fellows or residents. The feedback form response rate was 78% (<i>n</i> = 39). On the Likert scale, participants rated realism of the calf model to simulate robotic IMA harvesting (0 = <i>not realistic</i>, 10 = <i>highly realistic</i>) with a median of 8 out of 10 (interquartile range [IQR] 7 to 9). Participant confidence (0 = <i>not at all confident</i>, 10 = <i>very confident</i>) in robotic IMA harvesting before and after using the simulator increased (<i>P</i> = 0.001) from a median of 5 (IQR 1 to 7) to 9 (IQR 7 to 10).</p><p><strong>Conclusions: </strong>This robotic IMA harvest simulation model is affordable, realistic, and improved participant confidence in robotic IMA harvest. It may provide a valuable training tool for surgeons learning robotic coronary bypass surgery and allows for training frequency necessary to pass basic learning curves.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1177/15569845241289132
Nader S Aboelnazar, Brandon R Loshusan, Michael W A Chu
Objective: Primary cardiac tumors are uncommon, often benign, but can be potentially life threatening. Minimally invasive endoscopic (ENDO) techniques have been shown to be a feasible alternative for tumor resection compared with conventional sternotomy (CS). This study compared the clinical and surgical outcomes of a small series of patients undergoing cardiac tumor resection operations.
Methods: Between November 2009 and December 2022, 34 consecutive patients underwent cardiac tumor resection using either ENDO (n = 21) or CS (n = 13) techniques. We compared early perioperative outcomes, echocardiographic outcomes, and long-term clinical and tumor recurrence outcomes.
Results: Baseline characteristics were similar between groups; however, the ENDO group included younger patients (56 ± 16 vs 62 ± 17 years) and more female patients (83% vs 53%). The tumor was located in the left atrium (n = 19, 56%), right atrium (n = 5, 15%), or either ventricle (n = 4, 12%). In-hospital mortality and stroke frequency were similar for both groups (n = 0). There was no significant difference in cardiopulmonary bypass or cross-clamp times, respiratory or renal failure, or intensive care unit or hospital lengths of stay. At follow-up (ENDO, 42 [2 to 131] months vs CS, 54 [1 to 156] months), there were no deaths in the ENDO group and 2 patients died in the CS group (P = 0.21). No patients in either group experienced tumor recurrence.
Conclusions: In selected patients, both ENDO and CS approaches to primary cardiac tumor resection were safe, effective, durable, and associated with similarly good early and late results.
目的:原发性心脏肿瘤并不常见,通常为良性,但有可能威胁生命。与传统的胸骨切开术(CS)相比,微创内窥镜(ENDO)技术已被证明是一种可行的肿瘤切除替代方法。本研究比较了一小批接受心脏肿瘤切除手术患者的临床和手术效果:2009年11月至2022年12月期间,34名患者连续接受了ENDO(21人)或CS(13人)技术的心脏肿瘤切除术。我们比较了早期围手术期结果、超声心动图结果以及长期临床和肿瘤复发结果:两组患者的基线特征相似,但ENDO组患者更年轻(56±16岁 vs 62±17岁),女性患者更多(83% vs 53%)。肿瘤位于左心房(19 例,56%)、右心房(5 例,15%)或任一心室(4 例,12%)。两组患者的院内死亡率和中风频率相似(n = 0)。心肺旁路或交叉钳夹时间、呼吸衰竭或肾衰竭、重症监护室或住院时间均无明显差异。随访期间(ENDO,42 [2 至 131] 个月 vs CS,54 [1 至 156] 个月),ENDO 组无死亡病例,CS 组有 2 名患者死亡(P = 0.21)。两组患者均无肿瘤复发:在选定的患者中,ENDO 和 CS 两种原发性心脏肿瘤切除术均安全、有效、持久,且早期和晚期效果相似。
{"title":"Long-Term Outcomes of Minimally Invasive Endoscopic Versus Sternotomy Surgical Resection of Primary Cardiac Tumors.","authors":"Nader S Aboelnazar, Brandon R Loshusan, Michael W A Chu","doi":"10.1177/15569845241289132","DOIUrl":"https://doi.org/10.1177/15569845241289132","url":null,"abstract":"<p><strong>Objective: </strong>Primary cardiac tumors are uncommon, often benign, but can be potentially life threatening. Minimally invasive endoscopic (ENDO) techniques have been shown to be a feasible alternative for tumor resection compared with conventional sternotomy (CS). This study compared the clinical and surgical outcomes of a small series of patients undergoing cardiac tumor resection operations.</p><p><strong>Methods: </strong>Between November 2009 and December 2022, 34 consecutive patients underwent cardiac tumor resection using either ENDO (<i>n</i> = 21) or CS (<i>n</i> = 13) techniques. We compared early perioperative outcomes, echocardiographic outcomes, and long-term clinical and tumor recurrence outcomes.</p><p><strong>Results: </strong>Baseline characteristics were similar between groups; however, the ENDO group included younger patients (56 ± 16 vs 62 ± 17 years) and more female patients (83% vs 53%). The tumor was located in the left atrium (<i>n</i> = 19, 56%), right atrium (<i>n</i> = 5, 15%), or either ventricle (<i>n</i> = 4, 12%). In-hospital mortality and stroke frequency were similar for both groups (<i>n</i> = 0). There was no significant difference in cardiopulmonary bypass or cross-clamp times, respiratory or renal failure, or intensive care unit or hospital lengths of stay. At follow-up (ENDO, 42 [2 to 131] months vs CS, 54 [1 to 156] months), there were no deaths in the ENDO group and 2 patients died in the CS group (<i>P</i> = 0.21). No patients in either group experienced tumor recurrence.</p><p><strong>Conclusions: </strong>In selected patients, both ENDO and CS approaches to primary cardiac tumor resection were safe, effective, durable, and associated with similarly good early and late results.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1177/15569845241288550
Andre Luiz Tyszka, Alexandro Jose Jorge, Harissa El Ghoz
{"title":"Dealing With the Aortic Annulus: Surgical Aortic Annulus Enlargement With a Balloon Catheter.","authors":"Andre Luiz Tyszka, Alexandro Jose Jorge, Harissa El Ghoz","doi":"10.1177/15569845241288550","DOIUrl":"10.1177/15569845241288550","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}