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Robot-Assisted Minimally Invasive Coronary Artery Bypass Grafting: Total Arterial Revascularization Using the Double-Docking Technique. 机器人辅助微创冠状动脉旁路移植术:使用双对接技术进行全动脉再血管化。
IF 1.6 Q2 SURGERY Pub Date : 2024-07-01 Epub Date: 2024-09-12 DOI: 10.1177/15569845241266250
Meeranghani Mohammed Yusuf, Varun Bansal, Ashwin Venkatesh, Ganapathy Arumugam Chandrasekharan, Minal Vora, Aishwarya Mahesh Kumar

Objective: The right internal mammary artery is considered to be the second choice for arterial conduits for coronary artery bypass grafting (CABG). However, the widespread use of bilateral internal mammary artery (BIMA) grafting is limited owing to increased technical demands, lengthy procedure, and high incidence of sternal wound complications. We compared the early clinical outcomes of a novel robot-assisted double-docking technique (DDT) with an open sternotomy technique for total arterial revascularization using BIMA.

Methods: Between June 2019 and June 2023, 445 patients with multivessel coronary artery disease underwent open sternotomy CABG using BIMA grafting and 145 patients underwent robot-assisted BIMA grafting using DDT. Comparative analysis of 104 pairs of matched patients obtained using propensity score matching was performed. Procedural characteristics, postoperative 30-day mortality, and composite outcome (major adverse cardiac and cerebrovascular events) at a median follow-up of 1.5 years were evaluated.

Results: Preprocedural characteristics were well balanced between the groups after propensity matching. The number of distal anastomoses performed in the conventional group was statistically higher than that performed using DDT (P < 0.001). The durations of postsurgical ventilation, intensive care unit stay, and in-hospital stay were significantly lower with the DDT than with conventional CABG (P < 0.001). There was no significant difference in all-cause mortality or major adverse cardiac events between the DDT and conventional CABG groups at a median follow-up of 1.5 years.

Conclusions: The DDT is feasible and efficacious for revascularization of multiple coronary targets in select individuals. It is equivalent to open sternotomy in terms of early clinical outcomes and superior to open sternotomy with regard to rates of sternal infection and intensive care unit and in-hospital stay.

目的:右乳内动脉被认为是冠状动脉旁路移植术(CABG)动脉导管的第二选择。然而,由于技术要求提高、手术时间长、胸骨伤口并发症发生率高,双侧乳内动脉(BIMA)移植术的广泛应用受到限制。我们比较了新型机器人辅助双对接技术(DDT)与开放式胸骨切开技术在使用BIMA进行全动脉血管再通的早期临床效果:2019年6月至2023年6月期间,445名多血管冠状动脉疾病患者接受了使用BIMA移植术的开胸CABG,145名患者接受了使用DDT的机器人辅助BIMA移植术。采用倾向评分匹配法对104对匹配患者进行了比较分析。对手术特征、术后30天死亡率以及中位随访1.5年的综合结果(主要不良心脑血管事件)进行了评估:结果:经过倾向匹配后,两组患者的术前特征非常均衡。在统计学上,常规组进行的远端吻合次数高于使用 DDT 进行的吻合次数(P < 0.001)。DDT 组的术后通气时间、重症监护室住院时间和住院时间均显著低于常规 CABG 组(P < 0.001)。在中位随访1.5年期间,DDT组和传统CABG组在全因死亡率或主要心脏不良事件方面没有明显差异:结论:DDT 对特定人群的多冠状动脉靶点血运重建是可行且有效的。就早期临床效果而言,它与开胸胸骨切开术相当,而在胸骨感染率、重症监护室和住院时间方面则优于开胸胸骨切开术。
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引用次数: 0
Contemporary Bridge to Heart Transplantation With Venoarterial Extracorporeal Membrane Oxygenation. 利用静脉体外膜氧合技术实现心脏移植的当代桥梁
IF 1.6 Q2 SURGERY Pub Date : 2024-07-01 DOI: 10.1177/15569845241272161
Omar M Sharaf, Ryan Azarrafiy, Jeffrey P Jacobs, Giles J Peek, Mustafa M Ahmed, Alex Parker, Mohammad A Al-Ani, Feriel Esseghir, Juan Vilaro, Juan Aranda, Ahmet Bilgili, Mark S Bleiweis, Eric I Jeng

Objective: In October 2018, the United Network for Organ Sharing changed their heart allocation criteria to prioritize patients on temporary mechanical circulatory support. This study assesses outcomes of patients bridged to orthotopic heart transplantation (OHT) with venoarterial extracorporeal membrane oxygenation (VA ECMO) since this change. Methods: We conducted a retrospective single-center study of adults (≥18 years) supported with VA ECMO at the time of OHT (October 1, 2018, to December 31, 2021). The primary outcome was midterm survival. Results: During the study period, 117 patients underwent OHT including 52 adults ≥18 years (44%) and 65 children <18 years (56%). Among adults, 8 (15%) were supported with VA ECMO at the time of OHT and are included in this study; 75% were male (n = 6), and the median age was 52.5 (interquartile range [IQR] = 23.5 to 57.25) years. Most patients were peripherally cannulated (75%, n = 6) and supported with an intra-aortic balloon pump during the pretransplant period (87.5%, n = 7). The median ECMO duration was 7 (IQR = 4.5 to 25.25) days. Three patients experienced complications on ECMO (37.5%), including thromboembolic bowel infarction (12.5%, n = 1) and bleeding requiring reintervention (25%, n = 2). All patients survived to discharge without posttransplantation complications and were alive at the latest follow-up. The median follow-up time was 24.8 (IQR = 19.5 to 28.2) months. Conclusions: Patients can be successfully bridged with VA ECMO directly to OHT with excellent midterm results. Key contributors to our outcomes include early extubation, use of bivalirudin over heparin, ambulation, and rehabilitation while on ECMO.

目的:2018 年 10 月,器官共享联合网络(United Network for Organ Sharing)改变了心脏分配标准,优先考虑接受临时机械循环支持的患者。本研究评估了自这一变化以来,通过静脉体外膜氧合(VA ECMO)桥接至正位心脏移植(OHT)患者的预后。方法:我们对OHT时(2018年10月1日至2021年12月31日)接受VA ECMO支持的成人(≥18岁)进行了一项回顾性单中心研究。主要结果是中期存活率。研究结果在研究期间,117 名患者接受了 OHT,其中包括 52 名≥18 岁的成人(44%)和 65 名儿童(n = 6),中位年龄为 52.5 岁(四分位距[IQR] = 23.5 至 57.25)。大多数患者在移植前都进行了外周插管(75%,n = 6),并使用主动脉内球囊泵支持(87.5%,n = 7)。ECMO 中位持续时间为 7 天(IQR = 4.5 至 25.25)。三名患者在 ECMO 期间出现并发症(37.5%),包括血栓栓塞性肠梗死(12.5%,n = 1)和需要再次介入的出血(25%,n = 2)。所有患者均顺利出院,未出现移植后并发症,最近一次随访时均健在。中位随访时间为 24.8 个月(IQR = 19.5 至 28.2 个月)。结论:患者可以通过 VA ECMO 成功地直接过渡到 OHT,并取得良好的中期效果。早期拔管、使用比伐卢定而非肝素、行走以及在 ECMO 期间进行康复训练是取得疗效的关键因素。
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引用次数: 0
Evaluating the Feasibility of a Novel Micro Titanium Fastener to Facilitate Robot-Assisted Coronary Artery Bypass Grafting. 评估新型微型钛紧固件促进机器人辅助冠状动脉旁路移植术的可行性。
IF 1.6 Q2 SURGERY Pub Date : 2024-07-01 Epub Date: 2024-09-13 DOI: 10.1177/15569845241266596
Gianluca Torregrossa, Massimo Baudo, Amanda Yakobitis, Courtney Murray, Shaelyn M Cavanaugh, Kyle C Purrman
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引用次数: 0
Totally Endoscopic Robotic Repair of Unroofed Coronary Sinus Syndrome. 完全内窥镜机器人修复无顶冠状动脉窦综合征。
IF 1.6 Q2 SURGERY Pub Date : 2024-07-01 Epub Date: 2024-09-12 DOI: 10.1177/15569845241260303
Norihiko Ishikawa, Go Watanabe, Toru Koakutsu, Yuki Kato, Motomu Miyagi, Takafumi Horikawa, Shigeyuki Tomita, Toshiya Ohtsuka
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引用次数: 0
Periareolar Incision for Endoscopic Cardiac Surgery: How to Do It? 内窥镜心脏手术的乳晕周围切口:如何操作?
IF 16.4 Q2 SURGERY Pub Date : 2024-07-01 Epub Date: 2024-09-12 DOI: 10.1177/15569845241258776
Nithiananthan Mayooran, Eric E Vinck, Brian Swinnen, Jos G Maessen, Peyman Sardari Nia

Minimally invasive cardiac surgery (MICS) has demonstrated its efficacy in diminishing postoperative pain, accelerating early recovery, and facilitating a prompt return to daily activities. Notably, the periareolar incision has gained prominence owing to its superior cosmesis. This article elucidates the procedural details for implementing periareolar incision access in MICS and providing insights into its technique and applications.

微创心脏外科手术(MICS)在减轻术后疼痛、加速早期恢复和促进患者尽快恢复日常活动方面的疗效已得到证实。值得注意的是,乳晕周围切口因其优越的外观而备受瞩目。本文阐明了在多器官功能障碍手术中实施乳晕周围切口入路的程序细节,并对其技术和应用提供了深入的见解。
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引用次数: 0
Robot-Assisted Multivessel Coronary Artery Bypass Grafting: Step by Step. 机器人辅助多血管冠状动脉旁路移植术:循序渐进。
IF 1.6 Q2 SURGERY Pub Date : 2024-07-01 Epub Date: 2024-10-02 DOI: 10.1177/15569845241270527
Chase R Brown, John J Kelly
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引用次数: 0
Induced Moderate Hypothermia in Aortic Rupture With Retroperitoneal Bleeding: A Randomized Porcine Study. 主动脉破裂伴腹膜后出血时的中度低温诱导:一项随机猪研究。
IF 1.6 Q2 SURGERY Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI: 10.1177/15569845241253234
Artai Pirouzram, Maria Wikström, Thomas Larzon, Éva Tamás, Kristofer F Nilsson

Objective: Induced hypothermia improves outcome in aortic arch surgery, neonatal neurointensive care, and transplant surgery for example. In contrast, spontaneous hypothermia has been associated with worse outcomes in patients suffering from hemorrhagic shock, mostly explained by its adverse effects on the coagulation system. We investigated if induced hypothermia would impair short-term survival in experimental aortic rupture with retroperitoneal bleeding.

Methods: Anesthetized pigs were randomized into 2 groups: hypothermia by peritoneal lavage of ice-cold Ringer's acetate and external cooling (n = 10) and normothermia (n = 10). Aortic rupture with retroperitoneal bleeding was induced by endovascular means creating a 6 mm hole in the retroperitoneal portion of abdominal aorta. Survival (primary outcome), hemodynamics, and arterial blood gases including lactate were collected and analyzed up to 180 min after aortic rupture.

Results: The body temperature (mean ± standard deviation) in the hypothermic group was 31.5 ± 1.0 °C and 38.7 ± 0.4 °C in the normothermic group at the time for aortic rupture. Survival up to 180 min after the retroperitoneal bleeding was significantly higher in the hypothermic compared with the normothermic group (P = 0.023).

Conclusions: Induced hypothermia did not impair survival in this experimental retroperitoneal aortic bleeding model in anesthetized pigs. This finding may indicate a minor role for the coagulation system in this type of bleeding.

目的:诱导低体温可改善主动脉弓手术、新生儿神经重症监护和移植手术等的预后。与此相反,自发低体温与失血性休克患者的不良预后有关,这主要是由于低体温对凝血系统的不利影响。我们研究了诱导低体温是否会影响实验性主动脉破裂伴腹膜后出血患者的短期存活率:方法:将麻醉猪随机分为两组:通过腹腔灌洗冰冷的醋酸林格氏液和外部冷却进行低体温(n = 10)和正常体温(n = 10)。腹主动脉破裂伴腹膜后出血是通过血管内方法在腹主动脉腹膜后部分开一个 6 毫米的小孔诱发的。收集并分析了主动脉破裂后 180 分钟内的存活率(主要结果)、血液动力学和动脉血气(包括乳酸):结果:主动脉破裂时,低体温组的体温(平均值 ± 标准差)为 31.5 ± 1.0 °C,常温组为 38.7 ± 0.4 °C。与体温正常组相比,低体温组腹膜后出血后180分钟内的存活率明显更高(P = 0.023):结论:诱导低体温不会影响麻醉猪腹膜后主动脉出血模型的存活率。这一发现可能表明凝血系统在这类出血中的作用较小。
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引用次数: 0
Spontaneous Coronary Artery Dissection, Takotsubo Cardiomyopathy, and Venoarterial Extracorporeal Membrane Oxygenation in Pregnancy. 妊娠期自发性冠状动脉夹层、Takotsubo 心肌病和静脉体外膜氧合。
IF 1.6 Q2 SURGERY Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI: 10.1177/15569845241252443
Jake L Cotton, James Makinen, Sarah Y Park, Alison Halpern Mungo, Muhammad Aftab, Jordan R H Hoffman, Michael T Cain
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引用次数: 0
Totally Endoscopic Redo Tricuspid Repair With a Modified Clover Triple Edge-to-Edge Technique. 改良三叶草三边对边技术的全内镜三尖瓣重修术
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-06-05 DOI: 10.1177/15569845241253279
Antonios Pitsis, Apostolia Marvaki, Konstantinos Lolakos, Martin Andreas
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引用次数: 0
Practice Patterns in Sternal Closure and Evaluation of Adoption of a Novel Sternal Closure Device. 胸骨闭合术的实践模式以及对采用新型胸骨闭合设备的评估。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-09 DOI: 10.1177/15569845241247792
Gardner Yost, Thomas Marten, Jeffrey Plott, Jonathan W Haft

Objective: The technique for sternal closure has remained largely unchanged owing to the efficacy, simplicity, and low cost of stainless-steel sternal wires. Despite their ubiquity, several other closure devices designed to address the complications associated with sternal wires such as sternal bleeding and dehiscence have become popular. We have developed a novel sternal closure device that reduces sternal bleeding and dehiscence. This study quantifies the use of currently available sternal closure devices and determines predicted uptake of the novel device.

Methods: An electronic survey, designed to determine practice patterns for sternal closure, was distributed to 70 US cardiac surgeons. The survey included a discrete choice section in which surgeons evaluated relative value of device attributes including cost, ease of emergent sternal reentry, and dehiscence risk.

Results: There were 70 surgeons from 30 states who completed the survey. The most frequent means of sternal closure was straight sternal wires (35.8%), followed by straight sternal wires plus figure-of-8 sternal wires (18.1%), double wires (10.9%), plates (10.2%), and other (25%). The relative utilization shifted from sternal wires to sternal plates as the risk for dehiscence increased. The adoption of the novel closure device was estimated at 34.6%.

Conclusions: The standard stainless-steel sternal wire remains the most common means of sternal reapproximation, but its utilization is lower in patients at high risk for sternal dehiscence. Based on this survey, there is acceptance in the community for a novel sternal closure device designed to address the limitations of traditional sternal closure methods.

目的:由于不锈钢胸骨线的功效、简便性和低成本,胸骨闭合技术在很大程度上保持不变。尽管不锈钢胸骨线无处不在,但其他几种旨在解决胸骨线相关并发症(如胸骨出血和开裂)的闭合装置也开始流行起来。我们开发了一种新型胸骨闭合装置,可减少胸骨出血和开裂。本研究量化了目前可用的胸骨闭合装置的使用情况,并确定了新型装置的预测使用率:向 70 名美国心脏外科医生发放了一份电子调查表,旨在确定胸骨闭合的实践模式。调查包括一个离散选择部分,由外科医生评估装置属性的相对价值,包括成本、紧急胸骨复位的难易程度和开裂风险:来自 30 个州的 70 名外科医生完成了调查。最常用的胸骨闭合方法是直胸骨线(35.8%),其次是直胸骨线加8字形胸骨线(18.1%)、双线(10.9%)、钢板(10.2%)和其他(25%)。随着开裂风险的增加,相对使用率从胸骨线转向胸骨板。新型闭合装置的采用率估计为34.6%:结论:标准不锈钢胸骨线仍是最常用的胸骨复位方法,但在胸骨开裂高风险患者中使用率较低。根据这项调查,社区接受了一种新型胸骨闭合装置,该装置旨在解决传统胸骨闭合方法的局限性。
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引用次数: 0
期刊
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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