Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery最新文献

Objective: Although robotic cardiac surgery is becoming more widely adopted for mitral valve procedures, robot-assisted tricuspid valve (TV) surgery is less common. We describe clinical and echocardiographic outcomes for 70 isolated and concomitant TV repair (TVr) cases.

Methods: Patients who underwent robotic totally endoscopic TV surgery at our institution were retrospectively reviewed. The da Vinci Si or Xi robot (Intuitive Surgical, Sunnyvale, CA, USA) was used for all cases, employing an 8 to 10 mm working port and using cardiopulmonary bypass on a beating heart. Early and midterm outcomes were reviewed, along with echocardiogram results when available.

Results: Between 2014 and 2024, 70 patients underwent TVr. Fourteen cases were isolated TV procedures and 56 were concomitant with mitral surgery. The mean patient age was 67 ± 14.4 years, 57% were female, and 11 patients (16%) had previous heart surgery. TVr with an annuloplasty band occurred in 97% of patients, 1 patient had a tissue valve replacement, and there were no conversions to sternotomy. Early mortality occurred in 1 patient (1.4%) with an observed to expected ratio of 0.4. Early postoperative echocardiography revealed none to mild residual tricuspid regurgitation (TR) in 65 patients (93%). Clinical follow-up was completed in 97% of patients. All-cause mortality occurred in 14 patients (20%), 11 of which were noncardiac, including cancer, gastrointestinal bleed, end-stage renal disease, SARS-CoV-2 infection, and drug overdose. Follow-up echocardiography results were available for 46 patients (66%) at a mean of 45 months, showing moderate or more recurrent TR in 6 patients (9%).

Conclusions: Robot-assisted totally endoscopic TV surgery, for both isolated and concomitant TV disease, is a safe and effective approach. The sternal-sparing nature allows for rapid recovery and positive midterm outcomes.

Objective: This study aims to identify the perceived barriers and factors contributing to the slow adoption of robotic technology among coronary surgeons.

Methods: We administered an anonymous online survey during the 2023 Society for Thoracic Surgeons (STS) Coronary Conference and included questions about factors associated with the lack of, or slow adoption of, robotics in coronary artery bypass surgery.

Results: A total of 75 coronary surgeons completed the anonymous online survey. Of these respondents, 30 surgeons (39.4%) reported having more than 15 years of experience as independent coronary surgeons. Among the 71 surgeons (95%) who were not using robotic technology, the barriers to adoption (from most important to less important) were lack of skill or experience with robotic technology (mean score, 2.56 ± 1.84), followed by the lack of referral of patients with hybrid or single-vessel disease from cardiologists (2.81 ± 1.76), the need for more support and learning opportunities (e.g., hands-on courses, online courses; 3.44 ± 1.98), and more data to support the efficacy and safety of robotic coronary surgery (3.63 ± 2.22). Moreover, 38 surgeons (50%) expressed a willingness to consider robotic coronary surgery if industry provided appropriate devices such as stabilizers and automated anastomotic devices. Finally, 53 surgeons (69.7%) reported being unaware of the Thoracic Surgery Foundation and STS Advanced Robotic Cardiac Surgery Fellowship award with a coronary track.

Conclusions: The findings from this survey identify the barriers to adopting robotic technology in coronary surgery. Addressing these barriers through targeted interventions could foster wider acceptance and use of robotic technology in coronary bypass surgery.

The choice of cannulation technique for cardiopulmonary bypass remains a critical decision in cardiac surgery with direct consequences for intraoperative management and patient outcomes. Central and femoral cannulation represent the 2 dominant approaches, each associated with unique anatomical considerations, hemodynamic implications, and perioperative risks. The correct selection of a cannulation strategy should limit the risk of embolic events and associated complications such as vascular injury and stroke. The purpose of this review is to provide a detailed comparison of central and femoral cannulation techniques, with an emphasis on clinical scenarios and outcomes, recent innovations, and state-of-the-art technology. By critically analyzing current evidence, we aim to offer insights into the optimal cannulation strategy tailored to specific patients.