Abstrakt Kardiochirurgie Červenec 2011

“Robotically assisted totally endoscopic coronary bypass surgery.”

Bonatti, J., T. Schachner, et al. (2011).

Circulation 124(2): 236-244.



“[Robot-assisted vascular reconstructions in the aortoiliac region].”

Dvorák, M., T. Novotný, et al. (2011).

Roboticky asistované cévní rekonstrukce aorto-ilické oblasti. 90(1): 42-45.


The objective of the study was to evaluate the results of the robot-assisted laparoscopic aortoiliofemoral reconstructions in a group of 45 patients. The procedure is performed using three surgical techniques–conventional for the dissection of the vessels in the groin and distal anastomosis creation; laparoscopic for the dissection of the abdominal aorta and robotic for the proximal anastomosis creation. Between May 2006 and May 2010 we operated on 45 patients (37 males, 8 females) at a mean age of 57 years for aortoiliac occlusive disease using robot-assisted laparoscopic approach. We assessed the perioperative and hospitalization data. We created 21 aortobifemoral, 22 aortofemoral and 2 iliofemoral bypasses. The median time of the proximal anastomosis creation was 23 minutes (range 18 to 50 minutes), median clamping time was 60 minutes (range 40 to 95 minutes), median total operating time was 295 minutes (range 180 to 475 minutes). The median estimated blood loss was 265 ml (range 50 to 1200 ml). The median ICU stay was 2 days (range 1 to 8 days). During the follow-up period (median 19 months; range 2 to 50 months), we observed 3 early occlusions (6.7%)–all due to an insufficient outflow. All occlusions were resolved by the extension of reconstructions. No renal, cardiac or pulmonary complications were observed. The 30-day mortality was 0%. Late complications: port-site hernia (2.2%). The secondary patency was 100%. The da Vinci robotic system allows a precise vascular anastomosis creation and blood loss minimization. The achieved results (clamping time, anastomosis time) are fully comparable to conventional vascular surgery. The robotic system eliminates the technical limitations of laparoscopic aortic anastomosis creation. Robot-assisted laparoscopic aortoiliofemoral bypass grafting seems a safe method with a low complication rate.


“Robotic Mitral Valve Repair for All Categories of Leaflet Prolapse: Improving Patient Appeal and Advancing Standard of Care.”

Suri, R. M., H. M. Burkhart, et al. (2011).

Mayo Clinic Proceedings.


OBJECTIVE: To characterize the early outcomes of robotic mitral valve (MV) repair using standard open techniques. PATIENTS AND METHODS: We prospectively studied 100 patients with severe mitral regurgitation due to leaflet prolapse who underwent robot-assisted MV repair using conventional open-repair techniques between January 1, 2008, and December 31, 2009, at Mayo Clinic, Rochester, MN. RESULTS: The mean age of the patients was 53.9 years; 77 patients (77%) were male. Fifty-nine patients (59%) had posterior leaflet prolapse, 38 (38%) had bileaflet disease, and 3 (3%) had isolated anterior leaflet prolapse. Median cross-clamp and bypass times decreased significantly during the course of the study (P less than .001). Median postoperative ventilation time was 0 hours for the last 25 patients, with most patients extubated in the operating room. No deaths occurred. Reexploration for postoperative bleeding occurred in 1 patient (1%); 3 patients (3%) required percutaneous coronary intervention. Median hospital stay was 3 days. One patient (1%) underwent mitral reoperation for annuloplasty band dehiscence. Residual regurgitation was mild or less in all patients at dismissal and 1 month postoperatively. Significant reverse remodeling occurred by 1 month, including decreased left ventricular end-diastolic diameter (-7.2 mm; P less than .001) and left ventricular end-diastolic volume (-61.0 mL; P less than .001). CONCLUSION: Robot-assisted MV repair using proven, conventional open-repair techniques is reproducible and safe and hastens recovery for all categories of leaflet prolapse. One month after surgery, significant regression in left ventricular size and volume is evident.


Wiedemann, D., N. Bonaros, et al. (2011). “Surgical problems and complex procedures: Issues for operative time in robotic totally endoscopic coronary artery bypass grafting.” Journal of Thoracic and Cardiovascular Surgery.


Objective: Robotically assisted totally endoscopic coronary artery bypass grafting (TECAB) is a viable option for closed chest coronary surgery, but it requires learning curves and longer operative times. This study evaluated the effect of extended operation times on the outcome of patients undergoing TECAB. Methods: From 2001 to 2009, 325 patients underwent TECAB with the da Vinci telemanipulation system. Correlations between operative times and preoperative, intraoperative, and early postoperative parameters were investigated. Receiver operating characteristic analysis was used to define the threshold of the procedure duration above which intensive care unit stay and ventilation time were prolonged. Demographic data, intraoperative and postoperative parameters, and survival data were compared. Results: Patients with prolonged operative times more often underwent multivessel revascularization (P < .001) and beating-heart TECAB (P =.023). Other preoperative parameters were not associated with longer operative times. Incidences of technical difficulties and conversions (P < .001) were higher among patients with longer operative times. Prolonged intensive care unit stay, mechanical ventilation, hospital stay, and with requirement of blood products were associated with longer operative times. Receiver operating characteristic analysis showed operative times >445 minutes and >478 minutes to predict prolonged (>48 hours) intensive care unit stay and mechanical ventilation, respectively. Patients with procedures >478 minutes had longer hospital stays and higher perioperative morbidity and mortality. Kaplan-Meier analysis revealed decreased survival among patients with operative times >478 minutes. Conclusions: Multivessel revascularization and conversions lead to prolonged operative times in totally endoscopic coronary artery bypass grafting. Longer operative times significantly influence early postoperative and midterm outcomes. © 2011 The American Association for Thoracic Surgery.