Methodist DeBakey cardiovascular journal最新文献

Robot-assisted minimally invasive surgery (RAMIS) offers numerous benefits over traditional open surgery, resulting in greater prevalence of use and range of approved procedures. The proliferation of RAMIS has highlighted a need for effective, robust, and objective methods for assessing robotic surgical skills. Traditionally, assessment has relied on expert observation using structured grading rubrics. Although validated and widely used, this method is also resource intensive and subject to reviewer bias. In response, recent work has explored the potential for more robust assessment methods, including the development of skill-based metrics, crowd-sourced assessment techniques, and automated evaluation systems. This review summarizes recent developments in robotic surgical technical skill assessment, focusing on studies using the da Vinci platform. Assessment methods are grouped into four categories: structured rubrics, skill-based metrics, crowd-sourcing techniques, and automated assessment models. Trends of note include adaptation of established rubrics for specific areas of specialty, the implementation of deep learning models for automated assessment, and a move to integrate crowd-sourcing platforms for efficient and inexpensive evaluation. While traditional grading rubric structures remain the standard, multilevel assessment strategies and objective feedback systems are gaining traction. Future work should seek to integrate task- and movement-based assessment into procedure-level evaluations to create more robust and generalizable models for assessment. These advances show a shift towards data-driven and objective assessment methods, which could improve surgical training and patient outcomes.

Medical robotics has evolved significantly over the past decades, with more robotic systems than ever now in hospitals. The use of robots for surgery has already revolutionized the surgical landscape by providing high accuracy, greater surgeon dexterity, 3-dimensional visualization capabilities, and the potential for telesurgery. At the same time, diverse medical imaging modalities such as X-ray, computed tomography, magnetic resonance imaging, and ultrasound can provide meaningful visual information required for pre- and intraoperative planning and guidance, which is particularly important for robotic surgery given the surgeon's limited direct view of the surgical workspace in minimally invasive procedures. This review provides an overview of robotics technology for surgery and image acquisition and describes the main steps involved in the processing of medical imaging and its use. The authors also share their views on what the future of robotics and imaging may look like for surgical applications given the recent advances in artificial intelligence, computer vision, and machine learning.

This Points to Remember column outlines the foundational strategies, technological integrations, and early outcomes that shaped our cardiovascular surgery program's initial success when opening a smart hospital in March 2025. Houston Methodist Cypress leveraged advanced artificial intelligence-driven systems to improve surgical outcomes and optimize patient care through real-time data integration with electronic health records. These tools were foundational to the hospital's design, resulting in optimization of patient-centered care through sustainable practices and efficiencies.

This edition of Poet's Pen features Akshayaa Chittibabu, the winner of the 2024 Michael E. DeBakey Medical Student Poetry Awards. Her poem, "pre-aphasia counseling for the neurologist's lover," is a poignant reminder of life's frailty and a striking example of the effectiveness of poetry to personalize the human aspects of disease. This annual contest is held in honor of Dr. Michael E. DeBakey (1908-2008), a pioneer in the field of cardiovascular surgery whose impact upon the practice of medicine cannot be overstated. In addition to being the preeminent cardiovascular surgeon of his day, he was a strong proponent of the medical humanities, which continue to provide an excellent avenue for physicians to connect with their patients. As demonstrated by Dr. Chittibabu's poetry, they can also serve as effective reminders of just how easily the boundary between physician and patient may be traversed.

Echocardiography and ultrasonography are mainstay imaging modalities for the diagnosis, management, and surveillance of widespread acute and chronic illnesses, including cardiovascular disease. As such, they contribute to improved outcomes. Skilled sonographers are currently required to perform complete diagnostic exams; however, a critical shortage of sonographers in isolated, rural, remote, and global locations contributes to known healthcare disparities. Telerobotic ultrasound systems, which assist sonographers in using a robotic arm to examine patients remotely, offers a potentially profound impact. While this approach represents the intersection of telehealth, robotics, and imaging, important logistics must be addressed to achieve widespread adoption. These include integration of systems and workflow, the need for robust networks, cybersecurity, haptic feedback, cost/billing, and regulatory aspects. The utility, development, technical requirements, and future applications for these technologies are described here.

This interactive CME case poses the challenge of diagnosing a male patient in his late 60s who presented to the emergency department of a tertiary care hospital with neurological symptoms. He complained of transient blurred vision lasting for 20 minutes and was later identified to be in shock.

Chylopericardium (CP), defined as the accumulation of chyle in the pericardial cavity, is a rare condition, especially in the absence of an identifiable secondary cause. Primary idiopathic chylopericardium (PIC) is even more uncommon, with limited cases reported in the literature. We report the case of a 43-year-old South Asian woman who presented with palpitations and fatigue. Echocardiography revealed a large pericardial effusion with signs of cardiac tamponade, necessitating emergent pericardiocentesis. The pericardial fluid aspirated was pinkish and turbid, which turned to milky white after centrifugation. Analysis of the pericardial fluid demonstrated a high triglyceride concentration, lymphocytic predominance, and fat globules, consistent with chylous effusion. A thorough diagnostic workup-including infectious, rheumatologic, and oncologic evaluations-was unrevealing, confirming a diagnosis of PIC. Lymphoscintigraphy was misleading in this case, with no thoracic duct abnormalities reported. Following an initial response to conservative management with pericardiocentesis and a medium-chain triglyceride-rich diet, the patient experienced recurrence of symptoms and fluid reaccumulation. Definitive management via thoracic duct ligation and pericardial window surgery was performed, resulting in complete resolution of the effusion. At 6-month follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights the importance of considering primary CP in the differential diagnosis of pericardial effusion. Absence of classical inflammatory signs and symptoms can be suggestive of chylous effusion. The report also supports surgical intervention as a definitive treatment even if lymphoscintigraphy does not reveal clear thoracic duct pathology.

Kommerell's diverticulum (KD) is a rare vascular anomaly characterized by aneurysmal dilation of the descending aorta at the origin of an aberrant subclavian artery, which can occur in either a right- or left-sided aortic arch. Aberrant right subclavian arteries are found in approximately 0.5% to 2% of the population while aberrant left subclavian arteries are less common, occurring in only 0.04% to 0.4%. KD is associated with aberrant subclavian arteries in 60% to 82% of cases. It is often identified incidentally during imaging studies performed for unrelated reasons, which contributes to the limited understanding of its natural progression. However, KD carries significant risks, including a 53% chance of aneurysm rupture and a 19% incidence of aortic dissection. As a result, surgical management is generally recommended. Although no standardized treatment exists, options include thoracic endovascular aortic repair, hybrid procedures, and open repair. Intervention is typically advised when the orifice diameter exceeds 3 cm and depth exceeds 5 cm due to elevated rupture risk. We present a case of incidentally detected KD originating from a right aortic arch with an aberrant left subclavian artery.

Wolff-Parkinson-White (WPW) syndrome is a congenital condition characterized by the presence of an accessory pathway (AP) that can lead to tachyarrhythmias such as atrial fibrillation (AF). Patients with WPW are at an increased risk of developing AF, with a prevalence of up to 30%. Despite successful ablation of the AP, AF recurrence remains a challenge, particularly in older patients or those with a history of AF. Concomitant pulmonary vein isolation (PVI) may help reduce the risk of recurrence by targeting atrial remodeling and pulmonary vein involvement in AF. This case describes a 70-year-old male with WPW and AF who underwent a combined PVI and AP ablation procedure. The patient remained free of AF post-procedure, suggesting that this approach may be effective in high-risk patients. Further randomized controlled trials are necessary to evaluate the efficacy of this combined approach in reducing AF recurrence compared to AP ablation alone, especially in older patients.

Despite medical advances and increased perioperative testing, mortality and cardiovascular complications of noncardiac surgery (NCS) have hardly declined since the early 2000s. Studies demonstrate a disproportionate overutilization of preoperative diagnostic testing with a concurrent underutilization of interventions that have been shown to meaningfully modify mortality. Consequently, there has been a paradigm shift in the approach to perioperative testing. Current thinking advocates for a more judicious and individualized approach-that is, reserving noninvasive testing for select cases at highest risk of periprocedural cardiovascular events, where it may more effectively alter management. Thus, this review provides an update of the latest evidence-based recommendations on preoperative diagnostic assessment of patients with cardiovascular risk factors undergoing NCS, proposes a framework that can be referenced when approaching such a patient in clinical practice, and highlights areas that need more data to guide decision-making in clinical practice.