“Technical advances in the ablation of atrial fibrillation.”
Ahmed, H. and V. Y. Reddy (2009).
Heart Rhythm 6(8 Suppl): S39-44.
There is now a general consensus that for patients with paroxysmal atrial fibrillation, the goal of a catheter ablation procedure should be electrical isolation of the pulmonary veins (PVs). Attaining acute PV isolation has been facilitated by the advent of electronatomic mapping systems that allow real-time 3-D reconstructions of cardiac chamber anatomy, as well as integration of pre-acquired CT/MR cardiac imaging. Nevertheless, chronic PV isolation continues to remain an elusive goal. This article reviews the development of imaging and balloon technologies that may bring the field closer to permanent PV isolation with a single procedure. Particularly with regard to persistent and long-standing persistent AF, this article also reflects on the use of robotic and linear ablation technologies to facilitate ablation of the atrial “substrate”.
“Advances in mitral valve repair.”
Anderson, C. A. and W. R. Chitwood (2009).
Future Cardiol 5(5): 511-516.
The results of mitral valve repair for structural disease are durable and are generally accepted to be superior to mitral valve replacement. Following the early pioneering work of Carpentier, most advances in mitral repair have involved performing the same repair through ever smaller incisions in hopes of minimizing tissue trauma. Mitral repair is now possible thru port access with videoscopic and robotic assistance. Transcatheter repair techniques are now being investigated and offer the possibility of mitral repair without the utilization of cardiopulmonary bypass.
“Robot-assisted cardiac surgery.”
Modi, P., E. Rodriguez, et al. (2009).
Interact Cardiovasc Thorac Surg 9(3): 500-505.
Recognition of the significant advantages of minimizing surgical trauma has resulted in a substantial increase in the number of minimally invasive (MI) cardiac surgical procedures being performed. Synchronously, technological advances in optics, instrumentation and perfusion technology have facilitated routine totally endoscopic robotic cardiac surgery using the da Vinci((R)) telemanipulation system (Intuitive Surgical Inc). This technology has been applied to many cardiac surgical procedures, in particular, mitral valve repair (MVP) and totally endoscopic coronary artery bypass grafting (TECAB), allowing the surgeon to operate through 5 mm port sites rather than a traditional median sternotomy. In this rapidly evolving field, we review the clinical results of robotic cardiac surgery.
“Does obesity affect operative times and perioperative outcome of patients undergoing totally endoscopic coronary artery bypass surgery?”
Wiedemann, D., T. Schachner, et al. (2009).
Interactive Cardiovascular and Thoracic Surgery 9(2): 214-217.
More and more patients undergoing coronary artery bypass grafting (CABG) are overweight. This patient group suffers from wound healing problems more often than normal-weight patients. Therefore, avoiding sternotomy in obese patients by using an endoscopic technique could be a promising approach. Robotic technology enables totally endoscopic coronary artery bypass grafting (TECAB) procedures. We investigated whether the intra-operative-times or perioperative-outcome after TECAB-procedure are negatively affected by obesity. Patients [n=127, 101 male, 26 female, median age 59 (31-77) yearsx, undergoing arrested-heart TECAB procedure were enrolled. The median body mass index (BMI) in this patient cohort was 26 (19-38). In detail, 27 patients were normal-weight (BMI<25 kg/2), 67 patients were 2 overweight (BMI 25.1-30 kg/m2 ), 29 patients were obese (BMI 30.1-33.9 kg/m2 ) and four patients were morbidly obese (BMI>34 kg/m2 ). There was no correlation between BMI (1) left internal mammary artery (LIMA) takedown-time [Spearman-rank correlation coefficient (R)=0.02; P=n.s.], (2) lipectomy and pericardiotomy-time (R=0.042, P=n.s.), (3) total operative-time (R=-0.083: P=n.s.), (4) cardiopulmonary-bypass-time (R=-0.012; P=n.s.), (5) aortic-endoocclusion-time (Rs-0.055; P=n.s.), (6) mechanical-ventilation-time (R=0.001, P=n.s.), (7) length of ICU-stay (R=0.04; P=n.s.), (8) length of hospital-stay (R=-0.103; P=n.s.) or (9) occurrence of intraandyor postoperative adverse events. In overweight, obese but also morbidly obese patients the TECAB procedure did not increase operative times or the rate of intra- or postoperative complications. This patient group, therefore, benefits from this less traumatic version of coronary surgery.