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

Objective: Minimally invasive mitral valve surgery (MIMVS) is being increasingly adopted worldwide. Pivotal to the safe conduct of the procedure is optimal visualization to allow detailed valve analysis and assessment of reparability. Positioning of conventional transthoracic left atrial retractors used during MIMVS may be time-consuming and can result in a limited view or thoracic bleeding. The aim of this study was to evaluate the safety and efficacy of the FlexCrown™ retractor by Geister (Tuttlingen, Germany), an innovative self-expandable left atrial retractor, during MIMVS.

Methods: A retrospective analysis was performed of 245 patients at 2 mitral specialist centers from January 2017 to July 2022. All patients underwent MIMVS via a right minianterolateral thoracotomy using the FlexCrown retractor.

Results: There were 129 female (53%) and 116 male (47%) patients with a mean age of 67 ± 10 years. The etiology of the mitral valve pathology was stenosis in 11% of patients (n = 27), regurgitation in 80% (n = 196), and mixed in 9% (n = 22). The device was used for both mitral valve repair (n = 125) and replacement (n = 120). There were no cases of tissue damage, dislodgement, or migration of the FlexCrown retractor. The postoperative transthoracic echocardiogram showed no or trivial mitral regurgitation in 90% of patients (n = 220).

Conclusions: The FlexCrown self-expandable left atrial retractor by Geister allows excellent and safe exposure of the mitral valve with fast deployment and removal during MIMVS. The use of this innovative retractor may represent a helpful alternative to conventional left atrial retractors.

Objective: Isolated tricuspid valve (TV) surgery remains underused despite guideline recommendations. This underuse may be related to perceived high risk in comorbid patients but also to high reported needs for postoperative permanent pacemaker implantation (PPI). It is conceivable that PPI can be prevented by operating on the beating heart (BH). We conducted a systematic review and meta-analysis assessing the influence of BH versus arrested heart (AH) technique on short-term and long-term outcomes after isolated TV surgery with a specific focus on PPI requirements.

Methods: Three databases were assessed. The primary outcome was the rate of postoperative PPI. Secondary endpoints included short-term and long-term survival, cardiopulmonary bypass (CPB) and procedural duration, intensive care unit (ICU) and hospital stay, and postoperative stroke incidence. Hazard ratios, odds ratios, and 95% confidence intervals were calculated. A pooled Kaplan-Meier survival curve after reconstruction analysis was generated for the endpoint of long-term survival. Random-effects models were used.

Results: A total of 1,157 studies were identified. Six observational studies from different countries were included in the analysis. The cohorts receiving either BH or AH technique for isolated TV surgery showed no significant differences in the rate of PPI (range: 6.3% to 18.2%) or any secondary outcomes, including short-term and long-term survival, CPB and procedural duration, ICU and hospital stay, or stroke incidence.

Conclusions: Our meta-analysis suggests that performing TV surgery on the BH is not likely to be associated with a reduced risk of postoperative PPI or with different incidences of major clinical endpoints.

Objective: To evaluate the impact of a novel multidisciplinary initiative, known as the Multimodal ENhanced Discharge (MEND), on length of stay (LOS) for patients undergoing minimally invasive coronary artery bypass grafting (MICS CABG).

Methods: The MEND program aims to optimize the patient's preoperative condition and increase preparedness, provide individualized perioperative care, and ensure early postdischarge follow-up to support active recovery and facilitate early discharge. This single-center, retrospective analysis reviewed LOS and readmission data for 198 consecutive patients who underwent MICS CABG by a single surgeon. Of these, 91 patients received routine care (RC) and 107 patients received care through the MEND program.

Results: The median ward (non-intensive care unit) LOS was significantly shorter by 33% in the MEND group versus the RC group (2 vs 3 days, P < 0.001), resulting in a 40% shorter median total hospital LOS in the MEND group versus the RC group (2 vs 5 days, P < 0.001). Readmission rates were 14.3% for RC and 6.6% in the MEND group (P = 0.12).

Conclusions: Implementation of the MEND program in patients undergoing MICS CABG was associated with significantly shorter overall hospital LOS without an increase in readmission rates. No statistically significant differences in baseline characteristics between the RC and MEND cohorts were observed. These findings suggest MEND is an effective and generalizable program for optimizing recovery. Ultimately, this model of care has the potential to positively affect health care costs, improve surgical wait times, and expand capacity in MICS CABG programs.

Objective: To report the short-term real-word clinical and hemodynamic performance from the MANTRA study in patients undergoing minimally invasive mitral valve repair (MI-MVr) with the MEMO 4D ring (Corcym S.r.l., Saluggia, Italy).

Methods: MANTRA is an ongoing prospective study, evaluating the real-life safety and performance data on Corcym devices. Clinical and echocardiographic core lab-assessed outcomes were collected preoperatively, at discharge, and at follow-up, and Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12) questionnaires were administrated preoperatively and at 30 days. This analysis focused on patients who underwent MI-MVr with the MEMO 4D semirigid annuloplasty ring.

Results: Between July 2021 and October 2023, 97 patients were enrolled in 12 institutions. The mean age at surgery was 59.1 ± 11.9 years with a mean EuroSCORE II of 1.3 ± 1.3. Primary mitral regurgitation (MR) was the most common etiology. The 30-day mortality was 0%, and only 2 reoperations were reported within 30 days (2.1%). Surgery resulted in a marked improvement in patient New York Heart Association class, associated with a clinically significant increase in KCCQ-12 summary score. End-diastolic left ventricular diameter decreased from 55.06 ± 6.86 preoperatively to 50.13 ± 6.57 mm at 30-day follow-up, and left atrial volume decreased from 130.96 ± 50.04 preoperatively to 89.32 ± 39.65 mL at 30 days. Mean mitral pressure gradient was 3.156 ± 1.415 mm Hg. MR decreased significantly, with 44.6% of patients showing less than moderate MR.

Conclusions: In this study, MI-MVr with MEMO 4D ring was confirmed to be safe and effective, providing good clinical short-term outcomes, improvement of patient quality of life, and good early hemodynamic performance with optimal reduction of MR severity and preservation of left ventricular function.