”Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve.”
Arcidi Jr, J. M., E. Rodriguez, et al. (2011).
Journal of Thoracic and Cardiovascular Surgery.
Objective: Reoperative sternotomy to address mitral valve pathology carries substantial risk, especially with patent bypass grafts or an aortic valve prosthesis. We previously reported our early experience with minimally invasive right thoracotomy and peripheral cannulation as an alternative strategy, and we recently reviewed our cumulative 15-year hospital outcomes with this approach. Methods: Between June 1996 and April 2010, we performed right minithoracotomy for reoperations involving the mitral valve on 167 patients, 85 (51%) of these since 2006. Seventy-one percent had undergone previous coronary artery bypass grafting and 38% a previous valve procedure. Fibrillatory arrest was used in 77% and aortic clamping and root cardioplegia in 23%. Nineteen procedures were performed with robotic assistance. Results: Mitral repair frequency increased during each 5-year interval of our experience (1996-2000, 43%; 2001-2005, 53%; 2006-2010, 72%; P = .019), including 80% of native mitral valves without stenosis. Concomitant procedure frequency, most commonly atrial fibrillation ablation, also increased during each 5-year interval (0%, 21%, 48%; P < .0001). Thirty-day mortality was 3.0% (5/167), 0% since 2005. There were no conversions to sternotomy or aortic dissections. Stroke, in 2.4% (4/167), was statistically unrelated to fibrillatory arrest. Increased New York Heart Association functional class (odds ratio, 5.6; 95% confidence interval 1.1-27.8; P = .037) was the only independent predictor of mortality in multivariable analysis. Conclusions: Our updated experience confirmed the effectiveness of minimally invasive right thoracotomy to treat mitral pathology while avoiding reoperative sternotomy risk. We found fibrillatory and cardioplegic arrest methods to be safe myocardial preservation strategies with this approach. © 2011 The American Association for Thoracic Surgery.
“Robotic cardiac surgery: advanced minimally invasive technology hindered by barriers to adoption.”
Athanasiou, T., H. Ashrafian, et al. (2011).
Future Cardiol 7(4): 511-522.
Robotic cardiac surgery utilizes the most advanced surgical technology to offer patients a minimally invasive alternative to open surgery in the treatment of a broad range of cardiac pathologies. Although robotics may offer substantial benefits to physicians, patients and healthcare institutions, there are important barriers to its adoption that includes inadequate funding, competition from alternate therapies and challenges in training. There is a growing body of evidence to demonstrate the efficacy of robotic cardiac surgery. Technological innovations are improving patient safety and expanding the indications for robotic cardiac surgery beyond the treatment of mitral valve and coronary artery disease. Robotic cardiac surgery is rapidly becoming a feasible, safe and effective option for the definitive treatment of cardiac disease in the context of 21st century challenges to healthcare provision such as diabetes, obesity and an aging population.
“Robotic-assisted aortic valve bypass (apicoaortic conduit) for aortic stenosis.”
Gammie, J. S., E. J. Lehr, et al. (2011).
Annals of Thoracic Surgery 92(2): 726-728.
Aortic valve bypass (AVB [apicoaortic conduit]) surgery consists of the construction of a valved conduit between the left ventricular apex and the descending thoracic aorta. In our institution, AVB is routinely performed without cardiopulmonary bypass or manipulation of the ascending aorta or native aortic valve. We report the case of an 83-year-old man with severe symptomatic bioprosthetic aortic stenosis, chronic thrombocytopenia, and a patent bypass graft who underwent robotically assisted beating-heart AVB through an anterior minithoracotomy. The distal anastomosis was constructed entirely using robotic telemanipulation. Robotic assistance enables the performance of beating-heart AVB through a small incision.
“Robotic-assisted percutaneous coronary intervention proceed with caution.”
Kasasbeh, E. S. (2011).
JACC. Cardiovascular Interventions 4(8): 936.
“Robotic mitral valve surgery.”
Lehr, E. J., E. Rodriguez, et al. (2011).
European Surgery – Acta Chirurgica Austriaca.
BACKGROUND: Robotic mitral valve surgery has evolved and matured into a safe and reproducible procedure at multiple worldwide centers of excellence. METHODS: History of robotic mitral valve repair is reviewed. Current results and recent advances are discussed. RESULTS: Multiple trials have demonstrated that surgical outcomes for robotic mitral valve repair meet or exceed the results of conventional operations, but long-term studies are required. Patients undergoing robotic mitral valve repair experience improved quality of life and faster return to full activity compared to sternotomy patients. Although operative costs may be higher than sternotomy procedures, total hospital costs may be equivalent and societal costs are probably reduced. CONCLUSIONS: Continued technological and procedural advances extend the benefits of robotic surgery to a larger patient population. © 2011 Springer-Verlag.