Abstrakt Kardiochirurgie Únor 2012

Aybek, T. (2011). “Mitral valve surgery; from median sternotomy to closed chest procedures, from replacement to repair techniques/ Clinical outcomes of mitral valve repair in mitral regurgitation: A prospective analysis of 100 consecutive patients.” Mitral kapak cerrahisi, mediyan sternotomiden kapali{dotless} göǧüs işlemlerine, replasmandan onari{dotless}m tekniklerine/Mitral yetersizliǧinde mitral kapak onari{dotless}mi{dotless}ni{dotless}n klinik sonuçlari{dotless}: Ardi{dotless}şi{dotless}k 100 hastani{dotless}n prospektif analizi 11(8): 745-746.

Currie, M. E., J. Romsa, et al. (2012). “Long-Term Angiographic Follow-Up of Robotic-Assisted Coronary Artery Revascularization.” Annals of Thoracic Surgery.

BACKGROUND: Robotic-assisted coronary artery bypass grafting (CABG) has been shown in short-term studies to increase patient satisfaction and to reduce surgical morbidity and recovery times. However, the long-term patency rate of robotic-assisted CABG is unknown. Therefore, the objective of this study was to assess the long-term patency rate of robotic-assisted coronary artery bypass grafts. METHODS: The study cohort included all patients who underwent robotic-assisted conduit dissection for CABG at London Health Sciences Centre between September 1999 and December 2003. These patients had selective graft patency assessment using cardiac catheterization or computed tomography angiography (CTA), or both, and stress myocardial perfusion scintigraphy (MPS) 5 to 10 years after surgery to evaluate graft patency and to give functional information on the hemodynamic significance of any graft stenosis. Patients also completed quality of life questionnaires. RESULTS: From a total of 160 patients who underwent robotic-assisted CABG, 82 eligible patients were followed with graft patency assessments for a mean period of 8 years +/- 16.3 months. The patency rate of all robotic-assisted CABG grafts in this patient cohort was 92.7%. The patency rate of left internal thoracic artery grafts to the left anterior descending artery after robotic-assisted CABG in this patient cohort was 93.4%. Patients consistently attained high scores on quality of life questionnaires after surgery. CONCLUSIONS: The long-term patency rate of grafts after robotic-assisted CABG was 92.7% at a mean follow-up period of 95.8 +/- 16.3 months. Specifically, the patency rate of left internal thoracic artery grafts to the left anterior descending artery after robotic-assisted CABG was 93.4%.


Gao, C., M. Yang, et al. (2012). “Totally endoscopic robotic ventricular septal defect repair in the adult.” Journal of Thoracic and Cardiovascular Surgery.

OBJECTIVE: We have previously reported total endoscopic ventricular septal defect repair in the adult using the da Vinci S Surgical System. The optimal results encouraged us to extend the use of this technology to more complicated patients with ventricular septal defect. METHODS: From January 2009 to July 2010, 20 patients underwent total endoscopic robotic ventricular septal defect repair. The average patient age was 29.0 +/- 9.5 years (range, 16-45). Of the 20 patients, 9 were female and 11 were male. The echocardiogram demonstrated that the average diameter of the ventricular septal defect was 6.1 +/- 2.8 mm (range, 2-15), and 4 patients had concomitant patent foramen ovale. Ventricular septal defect closure was directly secured with interrupted mattress sutures in 14 patients and patched in 6 patients. All the procedures were completed using the da Vinci robot by way of 3 port incisions and a 2.0- to 2.5-cm working port in the right side of the chest. RESULTS: All patients were operated on successfully. The mean cardiopulmonary bypass and mean crossclamp time was 94.3 +/- 26.3 minutes (range, 70-140) and 39.1 +/- 12.9 minutes (range, 22-75), respectively. The mean operation time was 225.0 +/- 34.8 minutes (range, 180-300). The postoperative transesophageal echocardiogram demonstrated an intact ventricular septum. No residual left-to-right shunting and no permanently complete atrioventricular dissociation was found postoperatively. The mean hospital stay was 5 days. No residual shunt was found during a mean follow-up of 7 months (range, 1-22). The patients returned to normal function within 1 week without any complications. CONCLUSIONS: Total endoscopic robotic ventricular septal defect repair in adult patients is feasible, safe, and efficacious.


Gao, C., M. Yang, et al. (2012). “Robotically assisted mitral valve replacement.” Journal of Thoracic and Cardiovascular Surgery.

OBJECTIVE: In the present study, we determined the safety and efficacy of robotic mitral valve replacement using robotic technology. METHODS: From January 2007 through March 2011, more than 400 patients underwent various types of robotic cardiac surgery in our department. Of these, 22 consecutive patients underwent robotically assisted mitral valve replacement. Of the 22 patients with isolated rheumatic mitral valve stenosis (9 men and 13 women), the mean age was 44.7 +/- 19.8 years (range, 32-65). Preoperatively, all patients underwent a complete workup, including coronary angiography and transthoracic echocardiography. Of the 22 patients, 15 had concomitant atrial fibrillation. The surgical approach was through 4 right-side chest ports with femoral perfusion. Aortic occlusion was performed with a Chitwood crossclamp, and antegrade cardioplegia was administered directly by way of the anterior chest. Using 3 port incisions in the right side of the chest and a 2.5- to 3.0-cm working port, all the procedures were completed with the da Vinci S robot. RESULTS: All patients underwent successful robotic surgery. Of the 22 patients, 16 received a mechanical valve and 6 a tissue valve. The mean cardiopulmonary bypass time and aortic crossclamp time was 137.1 +/- 21.9 minutes (range, 105-168) and 99.3 +/- 17.9 minutes (range, 80-133), respectively. No operative deaths, stroke, or other complications occurred, and no incisional conversions were required. After surgery, all the patients were followed up echocardiographically. CONCLUSIONS: Robotically assisted mitral valve replacement can be performed safely in patients with isolated mitral valve stenosis, and surgical results are excellent.


Gao, C. Q., Y. Wu, et al. (2011). “[Robotically assisted coronary artery bypass grafting on beating heart].” Zhonghua Wai Ke Za Zhi (Chinese Journal of Surgery) 49(10): 923-926.

OBJECTIVES: To analyze the safety and efficiency of robotically assisted coronary artery bypass grafting (RACABG) on beating heart using da Vinci S system. METHODS: From January 2007 to March 2011, 105 patients underwent RACABG on beating heart through minithoracotomy. There were 77 male and 28 female patients, aged from 33 to 77 years with a mean of (59 +/- 10) years. After establishment of single left lung ventilation, the 3 trocars of da Vinci system were inserted into the left hemithorax, and robotic system was used to harvest the left internal mammary artery (LIMA) and/or right internal mammary artery (RIMA) from the subclavian vein to the internal mammary artery (IMA) bifurcation with skeletonized technique. After positioning the stabilizer, the LIMA was anastomosed manually to the left anterior descending or diagonal branch sequentially on beating heart through left minithoracotomy. The graft flow was evaluated by the Doppler flow meter after anastomosis was completed, and the graft patency was also evaluated by CT angiography or arteriography after surgery. RESULTS: All patients had successful RACABG on the beating heart, and the mean graft flow was (21 +/- 13) ml/min. One patient suffered from cardiac arrest after the first postoperative day, but he recovered soon and CT angiography showed that graft was patent. One patient with preoperative stroke had postoperative pulmonary infection, and was discharged after treatment. After 4 to 5 days, 4 patients received stent placement in right coronary artery or circumflex coronary in distinct hybrid session. There were no deaths or stroke or reintervention. All patients were discharged without complications and followed up. CTA or angiography revealed patent grafts in all patients, and the mean time of follow-up was (30 +/- 12) months. CONCLUSIONS: Robotically assisted coronary artery bypass grafting on beating heart can be performed safely using da Vinci S system. It is a new advanced approach of revascularization not only for patients with single vessel but with multi-vessel lesions as well.


McClure, R. S. and L. H. Cohn (2012). “Minimally invasive surgery for aortic stenosis in the geriatric patient: Where are we now?” Aging Health 8(1): 17-30.

Minimally invasive aortic valve surgery has evolved with time and become the routine approach for aortic surgery in select surgical centers. The success of these procedures in the nonelderly has led some to embark on using minimal access techniques in the geriatric population as well. With the geriatric community often inflicted with the greatest disease burden, suffering not only from a valvular process but also cumulative comorbidities, geriatric patients may be the patients most likely to derive benefit from a minimally invasive approach. Alternative therapies for symptomatic aortic stenosis include conventional full-sternotomy aortic valve replacement in addition to transcatheter aortic valve implantation. Each option has its advantages and disadvantages. The role of minimal access aortic valve surgery and its impact on the progressively aging population in the face of conventional surgery and transcatheter technology is discussed. © 2012 Future Medicine Ltd.