Abstrakt Kardiochirurgie Září 2010

“Erratum: How informed is “informed consent” for robotic cardiothoracic surgery? (Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery (2009) 4 (307-310)).”

(2010). Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5(4): 302.




“Degenerative mitral valve regurgitation: Best practice revolution.”

Adams, D. H., R. Rosenhek, et al. (2010).

European Heart Journal 31(16).


Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a ‘best practice revolution’ in the field of degenerative mitral valve regurgitation. © The Author 2010.




“Robot-assisted mitral valve repair: A single institution review.”

Bhamidipati, C. M., G. S. Mehta, et al. (2010).

Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5(4): 295-299.


Objective: Mitral valve repair (MVR) is the definitive therapy for mitral myxomatous degeneration. Median sternotomy has been the traditional approach to repair until the advent of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA). Minimally invasive surgical approaches for mitral repair have been slow to gain acceptance in cardiac surgery. We review the MVR results from our single-institution academic robotic program. Methods: From August 2004 through April 2008, patients who underwent a robotic-assisted (RA) MVR were identified. RA technique included a 4-cm right minithoracotomy, femoral cardiopulmonary bypass with transthoracic aortic occlusion, and RA-MVR. Repair types were combinations of quadrangular/triangular leaflet resection, sliding plasty, chordal transfer/replacement, and edge-to-edge approximation, with band annuloplasty in all cases. Postrepair echocardiography and morbidity follow-ups were completed in all patients. Our primary outcome was adequacy of repair, and secondary outcome was major complications. Results: There were 43 patients (29 male and 14 female) who underwent RA-MVR for severe (4+) mitral regurgitation during the 4-year review. Average operative time was 272.26 minutes. Only one patient had mild postoperative mitral regurgitation, whereas 20 had trace and 22 had no regurgitation after repair. Mean ventilator time was 32.1 hours, and length of stay was 5.7 days. One third of the patients (33%) received postoperative-packed red blood cell transfusions (average: 2.4 units per patient). Twenty-eight percent of patients developed atrial fibrillation after repair. Most of the patients (95.3%) were discharged home. There were no 30-day mortalities. Conclusions: Based on our small single-institution experience, RA-MVR provides an effective treatment for severe mitral valve regurgitation. Although procedure durability is slowly being established, preliminary results are promising. Careful programmatic advances with an integrated team approach can facilitate acceptable postoperative outcomes and excellent MVR. © 2010 by the International Society for Minimally Invasive Cardiothoracic Surgery.




“Totally endoscopic robotic ventricular septal defect repair.”

Gao, C., M. Yang, et al. (2010).

Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5(4): 278-280.


Objective: Recent advances in robotic instrumentation have facilitated totally endoscopic intracardiac procedures. However, totally endoscopic robotic ventricular septal defect (VSD) repair has not been reported in the literatures to our knowledge. We report our first three cases of closed chest VSD repair using da Vinci S Surgical System. Methods: Three female patients underwent totally endoscopic robotic VSD repair. Echocardiography demonstrated that the perimembranous VSD sizes in three patients were 6, 8, and 8 mm, respectively, and a patent foramen ovale in one patient. Results: All the VSD repair and right atrial closure were completed with the da Vinci robot. Mean cardiopulmonary bypass and mean cross-clamp times were 70 and 22 minutes, respectively. No blood transfusions were received. Postoperative transesophagel echocardiogram (TEE) demonstrated intact ventricular septum. The mean hospital stay was 5 days. The patients returned to normal function without any complications. Conclusions: With a limited number of cases, the study showed that totally endoscopic robotic VSD repair in adult patients is feasible and safe. © 2010 by the International Society for Minimally Invasive Cardiothoracic Surgery.




“Robotic dissection of the right internal thoracic artery through median sternotomy.”

Jatene, F. B., P. M. Pêgo-Fernandes, et al. (2010).

Dissecção robótica da artéria torácica interna direita por esternotomia mediana 94(6).


The use of robotic systems in cardiac surgeries aims at decreasing the surgical trauma. The totally endoscopic myocardial revascularization, assisted by the DaVinci robot (Intuitive Surgical, Sunnyvale, California) is feasible and the learning process must be carried out in steps. The first step is the preparation of the left internal thoracic artery, through the totally endoscopic approach. The case presented here proposes the dissection of the right internal thoracic artery through complete sternotomy. It proposes a new step directed at the totally endoscopic procedure, aiming at decreasing the injuries caused by the learning curve.




“Anesthesia management for robotically assisted endoscopic coronary artery bypass grafting on beating heart.”

Wang, G., C. Gao, et al. (2010).

Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5(4): 291-294.


Objective: To outline the initial anesthetic experience for robotically assisted coronary artery bypass grafting surgery on beating heart using the da Vinci surgical system. Methods: Between February 2007 and September 2009, 76 patients received the surgery with the da Vinci S Surgical System. The crucial issue of anesthesia for the surgery is to deal with the hemodynamic compromise, hypoxia and hypercarbia relevant to one-lung ventilation (OLV), and intrathoracic insufflation of CO<sub>2</sub> with positive pressure (CO <sub>2</sub> pneumothorax). Results: After initiation of OLV and CO<sub>2</sub> pneumothorax, PaO2 and mixed venous saturation showed a significant decrease. Meanwhile, the SpO2 decreased to 92% in 14 of the 76 patients. In these patients, application of continuous positive airway pressure setting 5 to 15 cm H2O to the collapsed lung resulted in an increase in PaO2 from 59 ± 12 to 115 ± 23 mm Hg (P &lt; 0.05). Moreover, at the beginning of CO <sub>2</sub> pneumothorax, the most dramatic fall in mean arterial pressure and cardiac index was showed with an increase in mean pulmonary artery pressure and heart rate. The hemodynamic compromise was counteracted by transfusion and inotropes/vasopressors. Postoperatively, the average extubation time was 7.5 ± 3.1 hours, and median intensive care unit length of stay was 21 hours. One patient remained in the intensive care unit for 3 days for treatment of a postoperative pneumonia. There were two cases of new onset postoperative atrial fibrillation. All patients were discharged home 4 to 7 days after surgery. Conclusions: Anesthetic management for the procedures requires detailed knowledge of OLV and CO<sub>2</sub> pneumothorax in addition to expertise required in conventional cardiac surgery. © 2010 by the International Society for Minimally Invasive Cardiothoracic Surgery.