“State-of-the-art and emerging technologies for atrial fibrillation ablation.”
Dewire, J. and H. Calkins (2010).
Nature Reviews. Cardiology 7(3): 129-138.
Catheter ablation is an important treatment modality for patients with atrial fibrillation (AF). Although the superiority of catheter ablation over antiarrhythmic drug therapy has been demonstrated in middle-aged patients with paroxysmal AF, the role the procedure in other patient subgroups-particularly those with long-standing persistent AF-has not been well defined. Furthermore, although AF ablation can be performed with reasonable efficacy and safety by experienced operators, long-term success rates for single procedures are suboptimal. Fortunately, extensive ongoing research will improve our understanding of the mechanisms of AF, and considerable funds are being invested in developing new ablation technologies to improve patient outcomes. These technologies include ablation catheters designed to electrically isolate the pulmonary veins with improved safety, efficacy, and speed, catheters designed to deliver radiofrequency energy with improved precision, robotic systems to address the technological demands of the procedure, improved imaging and electrical mapping systems, and MRI-guided ablation strategies. The tools, technologies, and techniques that will ultimately stand the test of time and become the standard approach to AF ablation in the future remain unclear. However, technological advances are sure to result in the necessary improvements in the safety and efficacy of AF ablation procedures.
“Robotically-assisted coronary artery bypass grafting.”
Folliguet, T. A., A. Dibie, et al. (2010).
Cardiol Res Pract 2010: 175450.
Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was 372 +/- 104 minutes and for MIDCAB was 220 +/- 69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.
“Differences Between Arterial and Expired Pump Carbon Dioxide During Robotic Cardiac Surgery.”
Song, J. G., E. H. Lee, et al. (2010).
Journal of Cardiothoracic and Vascular Anesthesia.
OBJECTIVE: To investigate whether expired pump carbon dioxide (PepCO(2)) is an effective arterial carbon dioxide (PaCO(2)) monitor during cardiopulmonary bypass (CPB) in patients undergoing robotic cardiac surgery compared with traditional cardiac surgery. DESIGN: A prospective control study. SETTING: A university, single-institutional setting. PARTICIPANTS: Sixty patients undergoing cardiac surgery. INTERVENTIONS: PepCO(2) was measured using a standard multigas analyzer with the monitoring catheter connected to the exhaust port of the oxygenator. The authors measured PaCO(2) values of the arterial blood provided to the patient and PepCO(2) from the oxygenator exhaust outlet during the cooling, stable hypothermia, and rewarming phases of CPB. MEASUREMENTS AND MAIN RESULTS: There were significant differences between temperature-uncorrected PaCO(2) (PaCO(2)tu) and PepCO(2) measured during the cooling phase; between temperature-corrected PaCO(2) (PaCO(2)tc) and PepCO(2); and between PaCO(2)tu and PepCO(2) measured during the stable hypothermia phase between the 2 groups (p < 0.001 for all). However, there were no significant differences between PaCO(2)tc and PepCO(2) measured during the cooling phase or between PaCO(2)tc and PepCO(2) or PaCO(2)tu and PepCO(2) measured during the rewarming phase between the 2 groups (p = 0.453, p = 0.122, and p = 0.412, respectively). CONCLUSION: These results reveal that PepCO(2) is not suitable for continuous monitoring of PaCO(2) during CPB in patients undergoing robotic cardiac surgery.
“Anesthetic management for robot assisted off-pump construction of composite graft using the da Vinci® surgical system.”
Takanashi, Y., H. Hamano, et al. (2010).
Japanese Journal of Anesthesiology 59(2): 193-196.
Robot-assisted minimally invasive surgery has become common in recent years. We used the da Vinci® surgical system and managed anesthesia in 6 cases of bilateral internal mammary artery dissection and construction of a composite graft using the radial artery. To ensure vision inside the thoracic cavity, endoscopic robotic surgery employs the inflation of the thoracic cavity with carbon dioxide, producing a pneumothorax and turning the thoracic cavity into a positive pressure chamber. Thus, marked acidosis and circulatory changes manifest during anesthetic management. Although robotic surgery is considered “minimally invasive”, such surgery involves a number of problems in terms of anesthetic management, and these problems must be examined.