Minimally invasive mitral valve surgery continues to. Minimally Invasive Mitral Valve Repair Using the da Vinci Robotic System
|
|
- Francine Hart
- 6 years ago
- Views:
Transcription
1 Minimally Invasive Mitral Valve Repair Using the da Vinci Robotic System Antone J. Tatooles, MD, Patroklos S. Pappas, MD, Paul J. Gordon, MD, and Mark S. Slaughter, MD Division of Cardiac Surgery, Advocate Christ Medical Center, Oak Lawn, Illinois Background. Minimally invasive mitral valve repair with a shortened hospital stay and quick return to an active lifestyle is the ultimate goal for robotically assisted surgery. We evaluated our da Vinci robotically assisted mitral valve repair experience toward achieving this goal. Methods. All procedures were performed with peripheral cardiopulmonary bypass, transthoracic aortic crossclamp, and antegrade cardioplegia. Two ports and a 4-cm intercostal incision in the right chest were used for access. All patients had a ring annuloplasty, and all but 1 had a posterior leaflet resection. The entire repair and all knot tying were performed robotically. Results. Between October 2001 and October 2002, 25 patients (18 men) underwent robotic mitral valve repair. The mean age was 56 years (range, 37 to 81 years). There were no incisional conversions, deaths, strokes, or reoperations for bleeding. Twenty-one (84%) of 25 patients were extubated in the operating room. Overall mean study times were as follows: procedure, minutes (range, 140 to 287 minutes); cardiopulmonary bypass, minutes (range, 89 to 186 minutes); and cross-clamp, 87.7 minutes (range, 58 to 143 minutes). Eight (32%) patients were discharged home in less than 24 hours, with an average length of stay of 2.7 days. Comparing the first 10 patients to the last 15 there was a significant reduction of times: total operating room time, versus minutes; cross-clamp, 97.6 versus 81.1 minutes; leaflet resection or repair, 26.2 versus 15.6 minutes; annuloplasty ring, 31.9 versus 24.8 minutes; and length of stay, from 4.2 days to 1.67 days. Five patients had postoperative atrial fibrillation. Two (8%) patients ultimately required mitral valve replacement for recurrent mitral insufficiency. Conclusions. Mitral valve repair can be successfully performed with the da Vinci robotic system. Long-term follow-up is needed to determine the durability of the repair compared with a standard sternotomy approach. (Ann Thorac Surg 2004;77: ) 2004 by The Society of Thoracic Surgeons Minimally invasive mitral valve surgery continues to evolve as a treatment option. Cohn and colleagues [1] and Cosgrove and associates [2] had shown that mitral and aortic valve procedures could be performed with a small incision by modifying the standard sternotomy. Criticisms of this approach include the concerns of limited access, increased technical difficulty, and limited visualization of the operative field. Casselman and colleagues [3] recently reported a large and successful series of endoscopic mitral valve repairs using an EndoCPB system. However, this technique requires significant endoscopic surgical skills and an aortic occlusion and cardioplegia delivery system that is not used frequently by all cardiac surgeons. With the introduction of the da Vinci robotic system (Intuitive Surgical, Inc, Sunnyvale, CA), many of the concerns of minimally invasive mitral valve repair were addressed. The da Vinci robotic system allows three-dimensional visualization of the operative Accepted for publication Nov 25, Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31 Feb 2, Address correspondence to Dr Slaughter, Cardiothoracic and Vascular Surgical Associates, SC, 4400 W 95th St, Suite 205, Oak Lawn, IL 60453; mscabg@aol.com. field and improved surgical manipulation by use of the endowrists of the surgical arms. Felger and coworkers [4], using a robotically directed approach, have subsequently demonstrated similar operative times with an improvement in length of stay and intubation time. The ultimate goal of minimally invasive surgery is to maintain excellent results while minimizing the hospitalization and interruption in daily life for the patient. With these goals in mind, we evaluated our experience with minimally invasive mitral valve repair using the da Vinci robotic system and its effect on postoperative ventilation, time in the intensive care unit, and overall length of stay. Material and Methods With institutional review board approval and informed consent, patients were enrolled in a Phase II US Food and Drug Administration approved multicenter trial (G000295) to evaluate mitral valve repair using the da Vinci robotic system. Between October 2001 and October 2002, 25 consecutive patients underwent robotically assisted mitral valve repair. All patients were symptomatic with severe (grade 3 or 4) mitral regurgitation. Patients had posterior leaflet disease only with generally pre by The Society of Thoracic Surgeons /04/$30.00 Published by Elsevier Inc doi: /j.athoracsur
2 Ann Thorac Surg TATOOLES ET AL 2004;77: DA VINCI ROBOTIC MITRAL VALVE REPAIR 1979 served ventricular function (ejection fraction 0.30). All inclusion and exclusion criteria are listed in Appendix A. The mitral valve was evaluated by echocardiography and quantitatively assessed preoperatively, intraoperatively, and postoperatively at 30 days. The echocardiograms were read by an independent cardiologist at a designated study core laboratory. With the anesthesiologists, an anesthesia protocol was developed to allow for consistent extubation in the operating room. The anesthesia technique used is listed in Appendix B. All data were prospectively collected. A Student s t test analysis was performed to determine statistical significance (GB-stat Version 6.5; Dynamic Microsystems, Inc, 1999, Silver Spring, MD). The patient is placed in the supine position with the right chest elevated approximately 30 degrees and the right arm secured above and across the patient s head. A radial arterial catheter and Swan-Ganz catheter are used for hemodynamic monitoring. External defibrillator patches are placed on the thoracic cage. A double-lumen endotracheal tube is inserted with right lung deflation. The right femoral artery and vein are cannulated for cardiopulmonary bypass. Additionally, a 17F wire-bound cannula is inserted in the right internal jugular vein for upper body venous return. A 4-cm incision is made in either the fourth or fifth intercostal space. The camera is placed through the anterior aspect of this incision, and it allows access for the patient-side surgeon to assist the console surgeon. Two additional ports are placed for the robotic arms. An antegrade cardioplegia needle is inserted into the ascending aorta through the working intercostal space. The ascending aorta is cross-clamped with a transthoracic aortic cross-clamp through a stab incision in the third intercostal space. The operative field is flooded with carbon dioxide. A standard longitudinal left atriotomy is performed. The left atrium is retracted using the Heartport retractor (Heartport, Inc, Redwood City, CA). The valve inspection, posterior leaflet resection, leaflet reapproximation, and ring annuloplasty (Cosgrove Edwards Annuloplasty Band, Edwards Life- Science, Irvine, CA) are all performed robotically. A quadrangular resection was performed when indicated, and the leaflets were reapproximated with a running suture. No annular plications or sliding annuloplasties were performed. All knot tying was also completed with the robot. Air was removed from the heart through the cardioplegia needle. A single chest tube was inserted to drain the right pleural space. The pericardium was not reapproximated, and pacing wires were not used. An intercostal nerve block with 1% Marcaine was performed before closing the chest. Anesthesia was planned to attempt intraoperative extubation in all patients. Results All 25 procedures were performed by the same patientside and console surgeons per trial protocol. The mean age of the patients was 56 years, and all but 1 had normal ventricular function (Table 1). Only 24% of the patients were in New York Heart Association class II or III. Table 1. Demographic Data Characteristic n 25 (%) Mean Range Age (y) Sex Female 7 (28%) Male 18 (72%) EF MR grade 3 9 (36%) 4 16 (64%) NYHA Class I 19 (76%) Class II 3 (12%) Class III 3 (12%) Smoking 11 (44%) Hypertension 11 (44%) Diabetes 0 (0%) Stroke 1 (4%) COPD 2 (8%) Hx 10 (40%) arrhythmia A-fib 4 (16%) V-tach 2 (8%) Other 4 (16%) A-fib atrial fibrillation; COPD chronic obstructive pulmonary disease; EF ejection fraction; Hx history; MR mitral regurgitation; NYHA New York Heart Association; V-tach ventricular tachycardia. Myxomatous degeneration with P2 prolapse was the cause of the mitral valve insufficiency in all 25 patients. Chordal rupture involving the posterior leaflet was also present in 13 (52%) patients. All patients had a ring annuloplasty, and 96% had a posterior leaflet resection with repair. The number of sutures required for securing the annuloplasty ring ranged from five to eight, with 88% receiving either six or seven horizontal mattress sutures. All knot tying was performed with the robot with five knots per suture. Sizing the annulus is difficult through the intercostal access, so the ring size was generally based on intraoperative transesophageal echocardiography annulus assessment. All but 1 patient received a 28-mm annuloplasty ring. Table 2. Operative Data (n 25) Variable Mean SD Range Total OR time (min) Procedure time (min) CPB (min) Cross-clamp (min) Leaflet resection or repair (min) Ring annuloplasty (min) CPB cardiopulmonary bypass; OR operating room; SD standard deviation.
3 1980 TATOOLES ET AL Ann Thorac Surg DA VINCI ROBOTIC MITRAL VALVE REPAIR 2004;77: Table 3. Postoperative Data (n 25) Variable N (%) Mean SD Range Extubated in OR 21 (84%) ICU (h) LOS (days) Discharged 24 h 8 (32%) Discharged 30 h 12 (48%) Pt s requiring PRBC s 11 (44%) ICU intensive care unit; LOS length of stay; OR operating room; PRBCs packed red blood cells; Pts patients; SD standard deviation. Table 2 details the time it took to complete the procedure as well as several individual components of the operation. The total operating room time was just less than 300 minutes. The actual time it takes to robotically resect and repair the posterior leaflet averaged 20 minutes. Insertion of the annuloplasty ring, placing sutures, and tying them was less than 30 minutes. The remainder of the cross-clamp time is needed for exposing the valve, valve inspection, interval dosing of cardioplegia, removing air, and closing the left atrium. The majority of the patients (84%) were extubated in the operating room (Table 3). The 4 patients who required postoperative ventilation in the intensive care unit were extubated in less than 5 hours. All patients were up in a regular chair in the evening of the same day they underwent surgery. The chest tube was removed the following morning unless an air leak was present or the total drainage was greater than 500 ml. Indications for transfusion of packed red blood cells were a hematocrit less than 24% while rewarming on cardiopulmonary Table 4. Postoperative Complications (n 25) Conversion to sternotomy 0 (0%) Reoperation for bleeding 0 (0%) Neurologic TIA a 1 (4%) CVA 0 (0%) Wound infection Chest 2 (8%) Groin 0 (0%) Groin lymphocele 1 (4%) Pulmonary Reintubation 0 (0%) Prolonged air leak b 1 (4%) Pleural effusion 1 (4%) Renal failure 2 (8%) A-fib 5 (20%) a Occurred 12 days after discharge. b Air leak requiring chest tube 24 h. A-fib atrial fibrillation; CVA cerebral vascular accident; TIA transient ischemic attack. bypass or a hematocrit less than 24% in the postoperative period. Using these guidelines, 11 patients required perioperative transfusion of packed red blood cells. The average time in the intensive care unit was 35.4 hours, with an overall length of stay of only 2.68 days. Eight (32%) patients were discharged home from the intensive care unit in less than 24 hours after the completion of their operation. Table 4 outlines the nonvalve-related complications encountered with robotically assisted mitral valve repair. There were no deaths, no conversions to a standard sternotomy, and no reoperations for bleeding. Two patients had cellulitis of the intercostal incision, and there were no groin wound infections. One patient did experience a lymphocele of the groin requiring surgical drainage and closure. There were no strokes, but 1 patient did have a transient ischemic attack 12 days after discharge. A transesophageal echocardiogram was suggestive of thrombus on the sewing ring. The patient received anticoagulation treatment and experienced no further symptoms. Despite the aggressive extubation protocol, no patient required reintubation. One patient did have a prolonged air leak requiring continued chest tube drainage that extended the length of stay. One other patient had a late pleural effusion that required a thoracentesis at an outside hospital. Two patients had an elevated creatinine (renal failure) that required no treatment. Five patients exhibited atrial fibrillation postoperatively. Two of these occurred while in the hospital. Two patients required readmission for rate control, and 1 was managed as an outpatient. A total of 7 (28%) patients required readmission after discharge. Only 3 of these patients had been discharged in less than 24 hours initially. The average time from discharge to readmission was 7 days (range, 1 to 13 days). Echocardiograms performed at 30 days postoperatively (n 24) revealed 12 (50%) patients had no mitral regurgitation, 11 (46%) patients had 1 mitral regurgitation, and only 1 (4%) patient had 2 mitral regurgitation. All patients were in New York Heart Association Class I and remain so at 12 to 24 months follow-up. Two patients ultimately required reoperation for mitral valve replacement. One patient was readmitted 3 days postoperatively for shortness of breath. An echocardiogram revealed new 2 mitral regurgitation, which progressed to 3 mitral regurgitation several days later. On reexploration the repair and ring were intact, but part of the anterior leaflet was torn from the annulus. The second patient was readmitted 40 days postoperatively for hemolytic anemia. Evaluation revealed 1 to 2 mitral regurgitation that was a high-velocity jet beneath an incompletely seated annuloplasty ring. At the time of valve replacement there was no evidence of infection. Table 5 divides our experience into two phases: the first 10 cases, which we considered our learning curve, and then our last 15 cases. There is a trend toward improved times for the overall procedure and cardiopulmonary bypass time, but they did not reach statistical significance. However, the cross-clamp time, leaflet resection or repair time, and annuloplasty ring time were
4 Ann Thorac Surg TATOOLES ET AL 2004;77: DA VINCI ROBOTIC MITRAL VALVE REPAIR 1981 Table 5. Initial Cases Versus Current Experience (n 25) a Variable 1st 10 Cases Last 15 Cases p Value Total OR time (min) Procedure time (min) CPB time (min) Cross clamp time (min) Leaflet repair (min) Annuloplasty ring (min) LOS (days) a Mean values. CPB cardiopulmonary bypass; LOS length of stay; OR operating room. significantly reduced in the second half of our experience. Our average length of stay is now down to 1.67 days, which is a significant improvement compared with our first 10 cases. Figure 1 demonstrates a typical wound 30 days postoperatively. Fig 1. Typical right thoracic wounds on postoperative day 30. Comment The evolution of minimally invasive mitral valve surgery continues to move forward. The early efforts, which involved modifications of the standard sternal incision, have now developed to the point at which the operation is performed almost entirely with robotic assistance. These stepwise improvements have followed the suggested steps and classification of minimally invasive cardiac surgery as reported by Loulmet and associates [5]. Successful series have been reported using port access, endovascular cardiopulmonary bypass, and aortic occlusion with a voice-controlled camera robotic arm [6, 7]. However, that technique requires the surgeon to learn new port access skills and the use of an endoaortic occlusion balloon, which can be difficult to position [8]. With the introduction of the transthoracic aortic crossclamp [9] and the da Vinci Surgical System, mitral valve repair can now be performed in a manner very similar to a standard sternotomy approach but with truly limited incisions. Nifong and colleagues [10] recently reported their successful initial results with the da Vinci system, which led to the multi-center trial. Because the technique and skills are familiar, there is a relatively short learning curve as demonstrated in the improvement in our series after the first 10 cases. Our operative times closely resemble those reported by Felger and coworkers [4] and Nifong and colleagues [10], who were able to show that mitral valve repair could be performed with similar operative times compared with standard techniques using a median sternotomy. Our current experience also demonstrates that robotically assisted mitral valve repair can be performed safely and with satisfactory early results. Realizing that mitral valve repair can be performed safely and with good long-term results through a sternotomy approach, is there any advantage to pursuing less-invasive mitral valve repair? Felger and coworkers [4] and Nifong and colleagues [10] now have a large experience with minimally invasive mitral valve repair and have shown clinical results equal to the conventional sternotomy approach but with decreased complications. In particular, there are fewer pulmonary complications and reoperations for bleeding. Intuitively, it would appear that this is a result of avoiding the sternotomy. We took this one step further with a planned anesthetic regimen to extubate the patients in the operating room. We successfully extubated more than 80% of patients in the operating room with no patient requiring reintubation. This has allowed for earlier ambulation and return of bowel function. Subsequently, patients can be considered for home discharge sooner with an average length of stay less than 48 hours in the last half of our experience. In those patients we discharged in less than 24 hours, 5 (63%) required no readmission and were seen only in the office as an outpatient. Because the readmission rate is not insignificant, the advantages of 24 to 48 hours postoperative discharge will require further evaluation. Chitwood and Nifong [11] have previously shown decreased costs of minimally invasive mitral valve repair compared
5 1982 TATOOLES ET AL Ann Thorac Surg DA VINCI ROBOTIC MITRAL VALVE REPAIR 2004;77: with conventional sternotomy. This was predominantly owing to a decrease in the length of stay. However, if one figures in the capital expenditure for the robot, service contracts, and disposable components, this becomes a controversial issue. There is no question that the better cosmetic result compared with a conventional sternotomy has improved our patient satisfaction. In our experience, 2 patients did require reoperation for recurrent mitral regurgitation. Both patients had less than 1 mitral regurgitation on their initial postoperative echocardiogram. The first patient had a partially torn anterior leaflet at the time of reoperation. This appeared to be a technical problem that was unrecognized at the initial procedure. The second patient had hemolysis from an incompletely seated annuloplasty ring. Because there is no tactile sensation, the knot tying depends on visual clues as to appropriate tension and tightness. Currently, the ring is inspected, including manipulation to make sure that it is snug on the annulus. Both of these failures occurred earlier in our overall experience. Thus, the learning curve includes not only a gradual improvement in times but an improvement in decision making and evaluating the valve repair itself. If the goal of minimally invasive mitral valve surgery is to perform the operation with reduced surgical trauma, decreased pain, fewer complications, improved cosmesis, shorter length of stay, and earlier return to a normal daily activity for the patient, then we believe that our series, as well as those by Casselman and associates [3], Felger and colleagues [4], Reichenspurner and associates [6], and Mohr and coworkers [7], has demonstrated the potential advantages of minimally invasive mitral valve surgery. However, the ultimate test will be the long-term durability and need for reoperation compared with a conventional sternotomy approach. Mohty and colleagues [12] have clearly established these long-term outcomes, which minimally invasive mitral valve surgery will have to match. Our study has provided additional information to the potential advantages of minimally invasive mitral valve surgery, such as improved cosmesis and fewer bleeding and pulmonary complications. The majority of patients can be extubated in the operating room with early ambulation. The role of early discharge ( 48 hours) needs additional evaluation owing to the relatively high readmission rate. Our patient population was generally young and healthy with good ventricular function. Whether or not this technique is feasible for morecomplex repairs or in elderly, sicker patients remains to be determined. Also, longer follow-up is needed to determine whether robotically assisted mitral valve repair in this select patient population is durable and will compare favorably to the 5- and 10-year results achieved through a sternotomy approach. References 1. Cohn LH, Adams DH, Couper GS, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Thorac Surg 1997;226: Cosgrove DM, Sabik JF, Navis JL. Minimally invasive valve operations. Ann Thorac Surg 1998;65: Casselman FP, Slycke SV, Dom H, Lambrechts DL, Vermeulen Y, Vanermen H. Endoscopic mitral valve repair: feasible, reproducible and durable. J Thorac Cardiovasc Surg 2003;125: Felger JE, Chitwood WR, Nifong LW, Holbert D. Evolution of mitral valve surgery: toward a totally endoscopic approach. Ann Thorac Surg 2001;72: Loulmet DF, Carpentier A, Cho PW, et al. Less invasive methods for mitral valve surgery. J Thorac Cardiovasc Surg 1998;115: Reichenspurner H, Boehm DH, Gulbins H, et al. Threedimensional video and robot-assisted port-access mitral valve operation. Ann Thorac Surg 2000;69: Mohr FW, Onnasch JF, Falk V, et al. The evolution of minimally invasive mitral valve surgery 2 year experience. Eur J Cardiothorac Surg 1999;15: Schneider F, Falk V, Walther T, Mohr FW. Control of endoaortic clamp position during port-access mitral valve operations using transcranial Doppler echography. Ann Thorac Surg 1998;65: Chitwood WR, Elbeery JR, Moran JF. Minimally invasive mitral valve repair using transthoracic aortic occlusion. Ann Thorac Surg 1997;63: Nifong LW, Chu VF, Bailey BM, et al. Robotic mitral valve repair: experience with the da Vinci system. Ann Thorac Surg 2003;75: Chitwood WR, Nifong LW. Minimally invasive videoscopic mitral valve surgery: the current role of surgical robotics. J Card Surg 2000;15: Mohty D, Orszulak TA, Schaff VH, Avierinos JF, Tajik JA, Sarano ME. Very long-term survival and durability of mitral valve repair for mitral valve prolapse. Circulation 2001; 104(Suppl 1):I-1 7. DISCUSSION DR W. RANDOLPH CHITWOOD (Greenville, NC): First, I would like to thank the authors for participating in the da Vinci Multicenter Mitral Valve Study in which 10 centers participated, as well as supplying me with the advanced copy of their manuscript. Doctor Tatooles and his coauthors have provided us, in an excellent presentation, data that support the continued exploration of using robotic assistance, or what really is telemanipulation, to do complete mitral valve repairs through truly minimal access incisions. These types of well-regulated clinical trials remain the touchstones for The Society for Thoracic Surgeons and our surgical specialties to advance and improve therapy for our patients. This is what it is all about. The results that Dr Tatooles and others have shown us today, and during the last several years, are helping to create a safe ascent up the Everest slope to a truly endoscopic mitral valve operation. Despite encouraging advancements, there are really three cautions for surgeons who choose this pathway of technologic development and applicative therapy. With these new devices and technologies, there are completely new learning curves, and albeit shortened by the amazing telemanipulative abilities of these devices, everyone must enter a common portal to a format that sets surgeons, both young and old, nearly at the same starting level.
6 Ann Thorac Surg TATOOLES ET AL 2004;77: DA VINCI ROBOTIC MITRAL VALVE REPAIR 1983 Second, we must not fool ourselves into thinking that this is a lesser operation because there is less tissue injury. The operation must be done with the same quality, long-term results, and standards for mitral valve repair surgery to which Professor Carpentier and others have held us. Last, any surgeon who does traditional mitral valve surgery well can provide his or her patients new benefits with these devices, but only if they have patience and can develop a completely new way of thinking about a way to do cardiac surgery. Doctor Tatooles has performed 25 mitral valve repairs along a well-planned protocol in which posterior leaflet resections were done, followed by a repair, and insertion of an annuloplasty band. All patients were followed by a protocol, through a third-party echocardiographic core laboratory, with follow-up transthoracic studies done 1 month after surgery. There were no deaths or incisional conversions in his group, and no strokes or myocardial infarctions occurred. One patient had a transient ischemic attack 7 days after discharge. Of all patients, 84% were extubated in the operating room, and the average length of stay was 2.7 days, which is the lowest in the multicenter trial that averaged 4.7 days in 112 patients. This is compared with the year 2002 STS data that showed a total length of stay of 8.5 days for repairs in nearly 900 patients. In Dr Tatooles s series, there were seven readmissions, or 28%, and two reoperations requiring a valve replacement. Forty-four percent of his patients received a transfusion. What Dr Tatooles has added to the multicenter protocol is a custom fast track anesthesia protocol with the intent of early extubation and early hospital discharge. In addition to a good repair, the course goal for the patient seems to have been preset, mainly at the very beginning, on rapid patient mobilization and cost reduction. Who can argue with these premises? However, although his cross-clamp, perfusion, and ventilatory times were significantly less than in our 60 patients, or many other patients in the multicenter trial, you still transfused 44% of your patients versus our 15% who received blood products. Moreover, your readmission rate was 28%. I was pleased to see that the cardiologists are referring to you patients who have severe regurgitation but are either asymptomatic or in no more than moderate congestive heart failure. Many are finding that these patients benefit most from a good repair by preventing atrial fibrillation and eventual ventricular impairment. I have several questions that arise from your study as well as from our observations and experience. You had two valve replacements, one within the first week from leakage and one at 40 days from hemolysis. Interestingly, we had a patient in our series who developed severe hemolysis and at reoperation was found to have a portion of the band that was not sewn flush with the tissue, creating a small fabric loop, which caused severe hemolysis. This patient had to have the valve replaced. This was in our early patient group, when our average number of sutures was eight. In your series, 76% of patients had only six sutures placed in a 28-mm Cosgrove annuloplasty band. In our last 30 of 60 patients, we have averaged 11 sutures to avoid this problem. Doctor Tatooles, are you expecting more hemolytic problems in your early patients and have you modified your technique since this reoperation? The ring or band must be placed as tight to the annular tissue as with sternotomy access. Clearly, the main reason that you were able to discharge your patients so early relates to your anesthetic method, early extubation, efficient pain control, liberal transfusions, and guided mobilization. We can learn a lot from this plan in managing all minimally invasive surgical patients. However, your 28% readmission rate bespeaks the fact that there seems to be an obligatory hospitalization period for any patient who undergoes any invasive cardiac procedure requiring perfusion and cardioplegic arrest. Our readmission rate has been almost nil, and we have not transfused nearly as many patients as have you, nor used a fast-track anesthesia protocol. In fact, our cardiopulmonary perfusion times are longer than yours, yet our length of stay is only a day or two longer at a mean of 3.9 days. Please comment on your readmissions and the reason for them. Last, having been a leader in this area, do you believe that we can achieve truly endoscopic telemanipulation for mitral surgery with instrument arms only without the need for even a small incision, and what are your thoughts for the future? Are there adjunctive facilitating technologies that are being developed that will help us? You and your colleagues are to be congratulated on a scientifically planned and well-executed study, for your honest results, for your excellent presentation, and for your solid attempts to improve patient care through the development of care protocols and new technologic methods, namely, computer-assisted telemanipulation using robotic devices. I would like to thank Drs Baumgartner, Guyton, and Murray as well as the scientific program committee for a superb meeting, and to thank the Society for the privilege of discussing this paper. God bless America. DR TATOOLES: Doctor Chitwood, thank you for your kind comments and your pioneering work in minimally invasive surgery and application of robotic techniques. In regards to our valve replacement, one patient did have a partial dehiscence of the posterior aspect of the annuloplasty ring. The etiology of this problem was not defined, but it may have been related to the number of sutures placed or to the technique of suture placement. Annuloplasty sutures are tied after the placement of each suture. This differs from our open technique and may increase the risk of ring dehiscence if the suture pulls partially through the annulus during placement of the subsequent stitch or kinks the annuloplasty ring. Placement of additional sutures may decrease the risk of ring dehiscence so long as sutures are placed under adequate tension to seat the ring against the annulus. We do not anticipate, nor have we seen, other patients developing complications related to hemolysis or ring dehiscence but will continue to follow our patients closely. In regards to our readmission rate, three of twelve patients discharged home on their first postoperative day were readmitted. Of these, one returned for symptomatic atrial fibrillation, one for upper extremity phlebitis, and one for a pleural effusion. An extended hospital stay would not have likely altered these complications. Early discharge did not contribute to postoperative morbidity, and select patients with close follow-up can be safely discharged on their first postoperative day. Although we did not specifically look at risk factors for transfusion requirements, 44% of our patients did receive blood or blood products. Early treatment of anemia may have facilitated our expedited discharge protocol; further evaluation of our transfusion threshold may decrease our perioperative use of blood and blood products. I would like to thank the Society for the privilege of allowing us to present our work. Thank you.
7 1984 TATOOLES ET AL Ann Thorac Surg DA VINCI ROBOTIC MITRAL VALVE REPAIR 2004;77: Appendix A Inclusion Criteria to 80 years of age 2. Has clinically significant mitral valve regurgitation (grade 3 or 4) 3. Has signed informed consent Preoperative Exclusion Criteria 1. Has any of the following echocardiographic findings: a. Mitral valve stenosis with moderate to severe mitral valvular calcification (any grade) b. Severely calcified mitral valve annulus c. Moderate to severe tricuspid valve insufficiency (grade 3 or 4) d. Moderate to severe aortic valve regurgitation or stenosis (grade 3 or 4) e. Left ventricular ejection fraction less than Has a history of acute myocardial infarction in preceding 30 days before proposed mitral valve surgery 3. Has hemodynamic instability with or without mitral valve disease or myocardial infarction 4. Has severe coronary artery disease requiring multivessel coronary artery bypass grafting 5. Has concomitant acute bacterial endocarditis 6. Has a previous right thoracotomy 7. Has a body mass index more than 35 kg/m 2 8. Has an anatomy unsuitable for endoscopic visualization of the thorax, eg, morbid obesity with remarkable axillary adiposity or physical deformities of the thorax 9. Has symptoms of severe asthma, emphysema, chronic obstructive pulmonary disease, or pulmonary fibrosis, or other evidence of pulmonary decompensation 10. Has significant hepatic compromise (cirrhosis, hepatitis, liver failure) 11. Has dialysis-dependent renal failure 12. Has untreated cerebrovascular disease 13. Has severe bleeding disorder 14. Has undergone previous radiation therapy of the mediastinum or right thorax 15. Has connective tissue disease (e.g., Marfan s syndrome, Ehlers-Danlos syndrome) 16. Has uncontrolled diabetes mellitus 17. Is unable to give informed consent 18. Is pregnant Appendix B Premedication Midazolam 1 to 3 mg intravenously Induction Sufentanil 1 to 2 g/kg intravenously Etomidate 0.2 to 0.5 mg/kg intravenously Maintenance Propofol 50 to 75 g kg 1 min 1 intravenously Sevoflurane 0% to 2% inhalation Reversal Neostigmine 5 mg intravenously Robinul 1 mg intravenously Postoperative Analgesia Ketorolac tromethamine 15 to 30 mg every 6 hours intravenously Morphine sulfate 1 to 5 mg every hour as needed intravenously
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease TIRONE E. DAVID, MD ; SEMIN THORAC CARDIOVASC SURG 19:116-120c 2007 ELSEVIER INC. PRESENTED BY INTERN 許士盟 Mitral valve
More informationLess invasive methods for mitral valve surgery have
Totally Endoscopic Mitral Valve Repair Using a Robotic-Controlled Atrial Retractor J. Michael Smith, MD, Hubert Stein, BS, BME, Amy M. Engel, MA, Sarah McDonough, and Lindsey Lonneman Department of Surgery,
More informationRobot-Assisted Cardiac Surgery Using the Da Vinci Surgical System: A Single Center Experience
Korean J Thorac Cardiovasc Surg 2015;48:99-104 ISSN: 2233-601X (Print) ISSN: 2093-6516 (Online) Robot-Assisted Cardiac Surgery Using the Da Vinci Surgical System: A Single Center Experience Eung Re Kim,
More information2/7/2018. Minimally-invasive Mitral Valve surgery at NYU
Department of Cardiothoracic Surgery Mitral Valve Surgery in the 21 st Century Eugene Grossi, MD SB Colvin Professor of Cardiothoracic Surgery Didier Loulmet, MD Director of Robotic Surgery NYU 22nd Annual
More informationMinimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques
Minimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques Konstadinos A Plestis, MD System Chief of Cardiothoracic and Vascular
More informationFacing Mitral Valve Surgery? Learn about minimally invasive da Vinci Surgery
Facing Mitral Valve Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Mitral Valve Prolapse Your mitral valve separates the upper and lower chambers of the left side of your heart.
More informationMinimally invasive mitral valve repair suggests earlier operations for mitral valve disease
Minimally invasive mitral valve repair suggests earlier operations for mitral valve disease James P. Greelish, MD Lawrence H. Cohn, MD Marzia Leacche, MD Michael Mitchell, MD Alexandros Karavas, MD John
More informationRepair or Replacement
Surgical intervention post MitraClip Device: Repair or Replacement Saudi Heart Association, February 21-24 Rüdiger Lange, MD, PhD Nicolo Piazza, MD, FRCPC, FESC German Heart Center, Munich, Germany Division
More informationPhD in Bioengineering and Medical-Surgical Sciences
PhD in Bioengineering and Medical-Surgical Sciences Research Title: Influence of different perfusion and aortic clamping techniques in minimally invasive mitral valve surgery Funded by None Supervisor
More informationUniversity of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives
University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty
More informationWhat s New in Mitral Valve Repair?
Original Article Daniel J. DiBardino, MD R. Saeid Farivar, MD, PhD From: Abbott Northwestern Hospital, Minneapolis, MN Address for correspondence: R. Saeid Farivar, MD, PhD Cardiothoracic Surgery Abbott
More informationMINIMALLY INVASIVE MITRAL VALVE SURGERY. Rohinton J. Morris, MD Chief, Cardiothoracic Surgery Jefferson University and Health Systems
MINIMALLY INVASIVE MITRAL VALVE SURGERY Rohinton J. Morris, MD Chief, Cardiothoracic Surgery Jefferson University and Health Systems OVERVIEW History Anatomy Indications Techniques Variants Outcomes &
More informationCARDIOCHIRURGIA MINI-INVASIVA: INVASIVA: efficacia per il paziente efficienza per la sanita. Dott. Davide Ricci
CARDIOCHIRURGIA MINI-INVASIVA: INVASIVA: efficacia per il paziente efficienza per la sanita Dott. Davide Ricci SC Cardiochirurgia U Universita degli Studi di Torino Minimally Invasive Surgical approaches
More informationClinical Results of Minimally Invasive Open-Heart Surgery in Patients with Mitral Valve Disease: Comparison of Parasternal and Low-Sternal Approach
Yonsei Medical Journal Vol. 47, No. 2, pp. 230-236, 2006 Clinical Results of Minimally Invasive Open-Heart Surgery in Patients with Mitral Valve Disease: Comparison of Parasternal and Low-Sternal Approach
More informationPosterior leaflet prolapse is the most common lesion seen
Techniques for Repairing Posterior Leaflet Prolapse of the Mitral Valve Robin Varghese, MD, MS, and David H. Adams, MD Posterior leaflet prolapse is the most common lesion seen in degenerative mitral valve
More informationKinsing Ko, Thom de Kroon, Najim Kaoui, Bart van Putte, Nabil Saouti. St. Antonius Hospital, Nieuwegein, The Netherlands
Minimal Invasive Mitral Valve Surgery After Previous Sternotomy Without Aortic Clamping: Short- and Long Term Results of a Single Surgeon Single Institution Kinsing Ko, Thom de Kroon, Najim Kaoui, Bart
More informationTechnical aspects of robotic posterior mitral valve leaflet repair
rt of Operative Techniques Technical aspects of robotic posterior mitral valve leaflet repair Hoda Javadikasgari, Rakesh M. Suri, Tomislav Mihaljevic, Stephanie Mick,. Marc Gillinov Department of Thoracic
More informationThe recent interest in minimal access surgery throughout
Partial Versus Full Sternotomy for Aortic Valve Replacement Michael F. Szwerc, MD, Daniel H. Benckart, MD, Robert J. Wiechmann, MD, Edward B. Savage, MD, Gary W. Szydlowski, MD, George J. Magovern, Jr,
More informationThe Edge-to-Edge Technique f For Barlow's Disease
The Edge-to-Edge Technique f For Barlow's Disease Ottavio Alfieri, Michele De Bonis, Elisabetta Lapenna, Francesco Maisano, Lucia Torracca, Giovanni La Canna. Department of Cardiac Surgery, San Raffaele
More informationSurgical Mininvasive Approach for Mitral Repair Prof. Mauro Rinaldi
Surgical Mininvasive Approach for Mitral Repair Prof. Mauro Rinaldi SC Cardiochirurgia U Universita degli Studi di Torino PORT-ACCESS TECNIQUE Reduce surgical trauma Minimize disruption of the chest wall
More informationMinimal access aortic valve surgery has become one of
Minimal Access Aortic Valve Surgery Through an Upper Hemisternotomy Approach Prem S. Shekar, MD Minimal access aortic valve surgery has become one of the accepted forms of surgical therapy for patients
More informationLong term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation
Featured Article Long term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation Igor Gosev 1, Maroun Yammine 1, Marzia Leacche 1, Siobhan McGurk 1, Vladimir Ivkovic 1, Michael
More informationSurgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea
Surgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea Contents Decision making in surgical AVR in old age Clinical results of AVR with tissue valve Impact of 19mm
More informationMinimally invasive mitral valve surgery: tips, tricks and technique
Surgical Technique on Cardiac Surgery Page 1 of 6 Minimally invasive mitral valve surgery: tips, tricks and technique Allen Cheng, Amy M. Ramsey Division of Cardiovascular and Thoracic Surgery, Oklahoma
More informationClinical outcomes of robotic mitral valve repair: a single-center experience in Korea
Featured Article Clinical outcomes of robotic mitral valve repair: a single-center experience in Korea Ho Jin Kim, Joon Bum Kim, Sung-Ho Jung, Jae Won Lee Department of Thoracic and Cardiovascular Surgery,
More informationReally Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients?
Really Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients? David H. Adams, MD Cardiac Surgeon-in-Chief Mount Sinai Health System Marie Josée and Henry R. Kravis Professor and
More informationMITRAL VALVE REPAIR. Solutions for minimally invasive cardiac surgery
MITRAL VALVE REPAIR Solutions for minimally invasive cardiac surgery The da Vinci Surgical System High-definition 3D vision EndoWrist instrumentation TilePro Multi-Input Display Allows the surgeon and
More informationMinimally Invasive Mitral Valve Surgery: A 6-Year Experience With 714 Patients
Minimally Invasive Mitral Valve Surgery: A 6-Year Experience With 714 Patients Eugene A. Grossi, MD, Aubrey C. Galloway, MD, Angelo LaPietra, MD, Greg H. Ribakove, MD, Patricia Ursomanno, MSN, Julie Delianides,
More informationStandard AVR. Full Sternotomy CPB
16.03.2013 by Dr. M. D. Dixit MS (Gen. Surg.), DNB (CVTS), PhD Professor & HOD, CVTS Director, KLES Heart Foundation, KLES Dr. Prabhakar Kore Hospital & MRC, Belgaum Standard AVR Full Sternotomy CPB
More informationIsolated Mitral Valve Repair in Patients With Depressed Left Ventricular Function
Isolated Mitral Valve Repair in Patients With Depressed Left Ventricular Function Ashish S. Shah, MD, Steven A. Hannish, MD, Carmelo A. Milano, MD, and Donald D. Glower, MD Department of General and Thoracic
More informationParasternal Approach for Minimally Invasive Aortic Valve Surgery
Parasternal Approach for Minimally Invasive Aortic Valve Surgery Lawrence H. Cohn Aortic valve replacement for the stenotic or regurgitant aortic valve has been one of the major advances of medical science
More informationThe value of a mitral valve operation is directly related to the efficacy of the. Endoscopic robotic mitral valve surgery
Surgery for Acquired Cardiovascular Disease Endoscopic robotic mitral valve surgery Douglas A. Murphy, MD, Jeffrey S. Miller, MD, David A. Langford, MD, and Averel B. Snyder, MD See related editorial on
More informationThruPort Ergonic Minimal Incision Instrumentation
I SEE MINIMAL INCISIONS * THRU Ergonic Minimal Incision Instrumentation. ThruPort Ergonic Minimal Incision Instrumentation *When compared to median sternotomy MIVS Redefined > THRUPORT SYSTEMS > TECHNOLOGY
More informationTERMS TOTAL ENDOSCOPIC ROBOTIC MITRAL SURGERY 3/17/2016 ROBOTIC MITRAL VALVE HISTORY PREPARED BY: DIANA FROEHLICH, CCP & AKILAH RICHARDS, CCP
TERMS TOTAL ENDOSCOPIC ROBOTIC MITRAL SURGERY PREPARED BY: DIANA FROEHLICH, CCP & AKILAH RICHARDS, CCP ROBOTIC MITRAL VALVE HISTORY 1 st Robotic MV Repair performed- 1998 Carpentier using early prototype
More informationAPOLLO TMVR Trial Update: Case Presentation
APOLLO TMVR Trial Update: Case Presentation Anelechi Anyanwu, MD, MSc, FRCS-CTh Professor and Vice-Chairman Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai New York, NY Disclosure
More informationAORTIC DISSECTIONS Current Management. TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida
AORTIC DISSECTIONS Current Management TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida DISCLOSURES Terumo Medtronic Cook Edwards Cryolife AORTIC
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Ablation, radiofrequency, anesthetic considerations for, 479 489 Acute aortic syndrome, thoracic endovascular repair of, 457 462 aortic
More informationChapter 24: Diagnostic workup and evaluation: eligibility, risk assessment, FDA guidelines Ashwin Nathan, MD, Saif Anwaruddin, MD, FACC Penn Medicine
Chapter 24: Diagnostic workup and evaluation: eligibility, risk assessment, FDA guidelines Ashwin Nathan, MD, Saif Anwaruddin, MD, FACC Penn Medicine Mitral regurgitation, regurgitant flow between the
More informationMyocardial enzyme release after standard coronary artery bypass grafting
Cardiopulmonary Support and Physiology Schachner et al Myocardial enzyme release in totally endoscopic coronary artery bypass grafting on the arrested heart Thomas Schachner, MD, a Nikolaos Bonaros, MD,
More informationRobot-Assisted Cardiac Surgery
doi: 10.5761/atcs.ra.15-00145 Review Article Norihiko Ishikawa, MD, PhD and Go Watanabe, MD, PhD Recognition of the significant advantages of minimizing surgical trauma has resulted in the development
More informationReplacement of the mitral valve in the presence of
Mitral Valve Replacement in Patients with Mitral Annulus Abscess Christopher M. Feindel Replacement of the mitral valve in the presence of an abscess of the mitral annulus presents a major challenge to
More informationDoes Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement?
Original Article Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Hiroaki Sakamoto, MD, PhD, and Yasunori Watanabe, MD, PhD Background: Recently, some articles
More informationQuality Outcomes Mitral Valve Repair
Quality Outcomes Mitral Valve Repair Moving Beyond Reoperation Rakesh M. Suri, D.Phil. Professor of Surgery 2015 MFMER 3431548-1 Disclosure Mayo Clinic Division of Cardiovascular Surgery Research funding
More informationHURDLES FOR STARTING MINISTERNOTOMY AORTIC VALVE REPLACEMENT PROGRAM IN OUR INSTITUTE
HURDLES FOR STARTING MINISTERNOTOMY AORTIC VALVE REPLACEMENT PROGRAM IN OUR INSTITUTE *Suraj Wasudeo Nagre Department of CVTS, Grant Medical College, Mumbai *Author for Correspondence ABSTRACT It s our
More informationSteph ani eph ani Mi M ck i MD Cleveland Clinic
Stephanie Mick MD Stephanie Mick MD Cleveland Clinic Upper hemisternotomy AVR Ascending Aorta MVr Thoracotomy Based Anterior AVR Lateral Thoracotomy Mitral/Tricuspid surgery Robotically assisted surgery
More informationAtrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationProf. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM
The Patient with Aortic Stenosis and Mitral Regurgitation Prof. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM Aortic Stenosis + Mitral Regurgitation?
More informationLess Invasive Reoperations for Aortic and Mitral Valve Disease. Peter Bent Brigham Hospital 1913
Shapiro CV Center 2008 Peter Bent Brigham Hospital 1913 Lawrence H. Cohn, MD, Professor of Cardiac Surgery, HMS Division of Cardiac Surgery, BWH, Boston, MA 70% of US valve patients select bioprosthetic
More informationMinimally invasive valve sparing mitral valve repair the loop technique how we do it
Art of Operative Techniques Minimally invasive valve sparing mitral valve repair the loop technique how we do it Stephan Jacobs, Simon H. Sündermann Division of Cardiovascular Surgery, University Hospital
More informationMinimally invasive mitral valve surgery: state-of-the-art and our experience
European Heart Journal Supplements (2015) 17 (Supplement A), A49 A53 The Heart of the Matter doi:10.1093/eurheartj/suv013 Minimally invasive mitral valve surgery: state-of-the-art and our experience Giuseppe
More informationHani K. Najm MD, Msc, FRCSC FACC, FESC President Saudi Society for Cardiac Surgeons Associate Professor of Cardiothoracic Surgery King Abdulaziz
Hani K. Najm MD, Msc, FRCSC FACC, FESC President Saudi Society for Cardiac Surgeons Associate Professor of Cardiothoracic Surgery King Abdulaziz Cardiac Centre Riyadh, Saudi Arabia Decision process for
More informationProfessor and Chief, Division of Cardiac Surgery Chief Medical Officer, Harpoon Medical. The Houston Aortic Symposium February 23-25, 2017
James S. Gammie, MD Professor and Chief, Division of Cardiac Surgery Chief Medical Officer, Harpoon Medical The Houston Aortic Symposium February 2-25, 2017 Disclosure Statement of Financial Interest Within
More informationRepair of Complete Atrioventricular Septal Defects Single Patch Technique
Repair of Complete Atrioventricular Septal Defects Single Patch Technique Fred A. Crawford, Jr., MD The first repair of a complete atrioventricular septal defect was performed in 1954 by Lillehei using
More informationAnn Thorac Cardiovasc Surg 2015; 21: Online April 18, 2014 doi: /atcs.oa Original Article
Ann Thorac Cardiovasc Surg 2015; 21: 53 58 Online April 18, 2014 doi: 10.5761/atcs.oa.13-00364 Original Article The Impact of Preoperative and Postoperative Pulmonary Hypertension on Long-Term Surgical
More informationInteresting Cases - A Case Report: Renal Cell Carcinoma With Tumor Mass In IVC And Heart. O Wenker, L Chaloupka, R Joswiak, D Thakar, C Wood, G Walsh
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 3 Number 2 Interesting Cases - A Case Report: Renal Cell Carcinoma With Tumor Mass In IVC And Heart O Wenker, L Chaloupka, R
More informationHee Young Kim 1, Seung-Hoon Baek 1, Hyung Gon Je 2, Tae Kyun Kim 1, Hye Jin Kim 1, Ji Hye Ahn 1, Soon Ji Park 1. Introduction
Original Article Comparison of the single-lumen endotracheal tube and doublelumen endobronchial tube used in minimally invasive cardiac surgery for the fast track protocol Hee Young Kim 1, Seung-Hoon Baek
More informationComparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse
European Journal of Cardio-thoracic Surgery 36 (2009) 532 538 www.elsevier.com/locate/ejcts Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse
More informationEbstein s anomaly is defined by a downward displacement
Repair of Ebstein s Anomaly Sylvain Chauvaud, MD Ebstein s anomaly is a tricuspid valve anomaly associated with poor right ventricular contractility in severe cases. Surgery is indicated in all symptomatic
More information(Ann Thorac Surg 2008;85:845 53)
I Made Adi Parmana The utility of intraoperative TEE has become increasingly more evident as anesthesiologists, cardiologists, and surgeons continue to appreciate its potential application as an invaluable
More informationTAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair?
TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair? Elaine E. Tseng, MD and Marlene Grenon, MD Department of Surgery Divisions of Adult Cardiothoracic and Vascular and Endovascular
More informationIndex. Note: Page numbers of article titles are in boldface type
Index Note: Page numbers of article titles are in boldface type A Acute coronary syndrome, perioperative oxygen in, 599 600 Acute lung injury (ALI). See Lung injury and Acute respiratory distress syndrome.
More informationUniversity of Bristol - Explore Bristol Research
Rogers, C., Capoun, R., Scott, L., Taylor, J., Angelini, G., Narayan, P.,... Ascione, R. (2017). Shortening cardioplegic arrest time in patients undergoing combined coronary and valve surgery: results
More informationThe operative mortality rate after redo valvular operations
Clinical Outcomes of Redo Valvular Operations: A 20-Year Experience Naoto Fukunaga, MD, Yukikatsu Okada, MD, Yasunobu Konishi, MD, Takashi Murashita, MD, Mitsuru Yuzaki, MD, Yu Shomura, MD, Hiroshi Fujiwara,
More informationΧειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας
Χειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας Dr Χρήστος ΑΛΕΞΙΟΥ MD, PhD, FRCS(Glasgow), FRCS(CTh), CCST(UK) Consultant Cardiothoracic Surgeon Normal Mitral Valve Function Mitral Regurgitation
More informationBicuspid aortic root spared during ascending aorta surgery: an update of long-term results
Short Communication Bicuspid aortic root spared during ascending aorta surgery: an update of long-term results Marco Russo, Guglielmo Saitto, Paolo Nardi, Fabio Bertoldo, Carlo Bassano, Antonio Scafuri,
More informationBioprosthetic Mitral Valve Dysfunction: Innovation and Evolution of a New Therapeutic Technique
Bioprosthetic Mitral Valve Dysfunction: Innovation and Evolution of a New Therapeutic Technique Charanjit S. Rihal MD MBA Professor and Chair Division of Cardiovascular Diseases Mayo Clinic DISCLOSURES
More informationMitral valve infective endocarditis (IE) is the most
Mitral Valve Replacement for Infective Endocarditis With Annular Abscess: Annular Reconstruction Gregory J. Bittle, MD, Murtaza Y. Dawood, MD, and James S. Gammie, MD Mitral valve infective endocarditis
More informationCatheter-based mitral valve repair MitraClip System
Percutaneous Mitral Valve Repair: Results of the EVEREST II Trial William A. Gray MD Director of Endovascular Services Associate Professor of Clinical Medicine Columbia University Medical Center The Cardiovascular
More informationTracheal stenosis in infants and children is typically characterized
Slide Tracheoplasty for Congenital Tracheal Stenosis Peter B. Manning, MD Tracheal stenosis in infants and children is typically characterized by the presence of complete cartilaginous tracheal rings and
More informationPort-Access Coronary Artery Bypass Grafting With the Use of Cardiopulmonary Bypass and Cardioplegic Arrest
Port-Access Coronary Artery Bypass Grafting With the Use of Cardiopulmonary Bypass and Cardioplegic Arrest Hermann Reichenspurner, MD, PhD, Vassilios Gulielmos, MD, Jaqueline Wunderlich, MD, Markus Dangel,
More informationHow has robotic repair changed the landscape of mitral valve surgery?
Perspective How has robotic repair changed the landscape of mitral valve surgery? Amit K. Taggarse, Rakesh M. Suri, Richard C. Daly Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905,
More informationCardiac Valve/Structural Therapies
Property of Dr. Chad Rammohan Cardiac Valve/Structural Therapies Chad Rammohan, MD FACC Medical Director, El Camino Hospital Cardiac Catheterization Lab Director, Interventional and Structural Cardiology,
More informationPort-Access Approach for Minimally Invasive Mitral Valve Surgery
Port-Access Approach for Minimally Invasive Mitral Valve Surgery Eugene A. Grossi, Greg Ribakove, Daniel S. Schwartz, Aubrey C. Galloway, and Stephen B. Colvin Port-access (PA) mitral valve surgery is
More informationPercutaneous mitral valve repair: current techniques and results
Percutaneous mitral valve repair: current techniques and results Ted Feldman, M.D., FSCAI, FACC Angioplasty Summit April 25-27 th th 2007 Seoul, Korea Ted Feldman MD, FACC, FSCAI Disclosure Information
More informationDr Nikolaos Baikoussis
Dr Nikolaos Baikoussis Cardiac Surgeon Evangelismos General Hospital of Athens, Greece STS database: any procedure not performed with a full sternotomy (FS) and cardiopulmonary bypass (CPB)..(TAVI) Schmitto
More informationAortic valve repair: When and how to employ this novel approach?
Aortic valve repair: When and how to employ this novel approach? Konstadinos A Plestis, MD System Chief of Cardiac Thoracic and Vascular Surgery Main Line Health Care System Professor Sidney Kimmel Medical
More informationLate redo-port access surgery after port access surgery
Interactive CardioVascular and Thoracic Surgery 22 (2016) 13 18 doi:10.1093/icvts/ivv281 Advance Access publication 13 October 2015 ORIGINAL ARTICLE ADULTCARDIAC Cite this article as: van der Merwe J,
More informationEACTS Adult Cardiac Database
EACTS Adult Cardiac Database Quality Improvement Programme List of changes to Version 2.0, 13 th Dec 2018, compared to version 1.0, 1 st May 2014. INTRODUCTORY NOTES This document s purpose is to list
More informationSingle-Center Experience with Minimally Invasive Mitral Operations through Right Minithoracotomy
doi: 10.5761/atcs.oa.18-00100 Original Article Single-Center Experience with Minimally Invasive Mitral Operations through Right Minithoracotomy Marek Pojar, MD, PhD, 1 Jan Vojacek, MD, PhD, 1 Mikita Karalko,
More informationDespite advances in our understanding of the pathophysiology
Suture Relocation of the Posterior Papillary Muscle in Ischemic Mitral Regurgitation Benjamin B. Peeler MD,* and Irving L. Kron MD,*, *Department of Cardiovascular Surgery, University of Virginia, Charlottesville,
More informationMinimally Invasive Mitral Valve Repair: Indications and Approach
Minimally Invasive Mitral Valve Repair: Indications and Approach Juan P. Umaña, M.D. Chief Medical Officer Director, Cardiovascular Medicine FCI - Institute of Cardiology Bogota Colombia 1 Mitral Valve
More informationResults of Mitral Valve Replacement, with Special Reference to the Functional Tricuspid Insufficiency
Results of Mitral Valve Replacement, with Special Reference to the Functional Tricuspid Insufficiency Ken-ichi ASANO, M.D., Masahiko WASHIO, M.D., and Shoji EGUCHI, M.D. SUMMARY (1) Surgical results of
More informationIschemic mitral regurgitation (IMR) is an insufficiency of
Repair Techniques for Ischemic Mitral Regurgitation Damien J. LaPar, MD, MSc, and Irving L. Kron, MD Ischemic mitral regurgitation (IMR) is an insufficiency of the mitral valve (MV) secondary to myocardial
More informationExpanding Relevance of Aortic Valve Repair Is Earlier Operation Indicated?
Expanding Relevance of Aortic Valve Repair Is Earlier Operation Indicated? RM Suri, V Sharma, JA Dearani, HM Burkhart, RC Daly, LD Joyce, HV Schaff Division of Cardiovascular Surgery, Mayo Clinic, Rochester,
More informationCIPG Transcatheter Aortic Valve Replacement- When Is Less, More?
CIPG 2013 Transcatheter Aortic Valve Replacement- When Is Less, More? James D. Rossen, M.D. Professor of Medicine and Neurosurgery Director, Cardiac Catheterization Laboratory and Interventional Cardiology
More informationEulogio Garcia MD Hospital Clínico San Carlos Madrid - Spain
Eulogio Garcia MD Hospital Clínico San Carlos Madrid - Spain Device Landscape 2010 PERCUTANEOUS TECHNIQUES Percutaneous indirect annuloplasty Percutaneous direct annuloplasty Edge to Edge ( E-Valve ) Non
More informationIntracardiac myxomas usually are managed by complete
Video-Assisted Minimal Access in Excision of Left Atrial Myxoma Po-Jen Ko, MD, Chau-Hsiung Chang, MD, Pyng Jing Lin, MD, Jaw-Ji Chu, MD, Feng-Chun Tsai, MD, Chuen Hsueh, MD, and Min-Wen Yang, MD Division
More informationThe radial procedure was developed as an outgrowth
The Radial Procedure for Atrial Fibrillation Takashi Nitta, MD The radial procedure was developed as an outgrowth of an alternative to the maze procedure. The atrial incisions are designed to radiate from
More informationRepair of Congenital Mitral Valve Insufficiency
Repair of Congenital Mitral Valve Insufficiency Roland Hetzer, MD, PhD, and Eva Maria Delmo Walter, MS, MD, PhD Principles of Mitral Valve Repair We believe that mitral valve repair for congenital mitral
More informationCORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW
CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW 2015 PQRS OPTIONS F MEASURES GROUPS: 2015 PQRS MEASURES IN CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP: #43 Coronary Artery Bypass Graft (CABG):
More informationIntroducing the COAPT Trial
physician INFORMATION Eligible patients Symptomatic functional mitral regurgitation 3+ Not suitable candidates for open mitral valve surgery NYHA functional class II, III, or ambulatory IV Introducing
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
202 NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of totally endoscopic robotically assisted coronary artery bypass surgery Introduction
More informationThe Florida Society of Thoracic & Cardiovascular Surgeons
The Florida Society of Thoracic & Cardiovascular Surgeons 2012 Annual Meeting Ocean Reef Club Key Largo, Florida CASE PRESENTATION Alfredo Rego MD, PhD South Florida Heart and Lung Institute INTRA-OPERATIVE
More informationPATIENT BOOKLET MEDTRONIC MITRAL AND TRICUSPID HEART VALVE REPAIR
PATIENT BOOKLET MEDTRONIC MITRAL AND TRICUSPID HEART VALVE REPAIR ARE MEDTRONIC HEART VALVE REPAIR THERAPIES RIGHT FOR YOU? Prosthetic (artificial) heart valve repair products are used by physicians to
More informationAfter unsuccessful attempts to perform totally endoscopic coronary
Robotic totally endoscopic coronary artery bypass: Program development and learning curve issues J. Bonatti T. Schachner O. Bernecker O. Chevtchik N. Bonaros H. Ott G. Friedrich F. Weidinger G. Laufer
More informationSurgery For Ebstein Anomaly
Surgery For Ebstein Anomaly Christian Pizarro, MD Chief, Pediatric Cardiothoracic Surgery Director, Nemours Cardiac Center Alfred I. dupont Hospital for Children Professor of Surgery and Pediatrics Sidney
More informationMinimally invasive video-assisted mitral valve surgery: the CardioMISS experience in more than 200 cases
Minimally invasive video-assisted mitral valve surgery: the CardioMISS experience in more than 200 cases V.G. RUGGIERI, A. Antonazzo, E. Gerbasi, A. Albertini, B. Madaffari, A. Agnino Cliniche Gavazzeni
More informationMinimally invasive surgical techniques have been successfully
Development of Robotic Enhanced Endoscopic Surgery for the Treatment of Coronary Artery Disease Utz Kappert, MD; Jens Schneider, MD; Romuald Cichon, MD; Vassilios Gulielmos, MD; Sems-Malte Tugtekin, MD;
More informationMinimally invasive aortic valve surgery: new solutions to old problems.
SCDU DI CARDIOCHIRURGIA Università degli Studi di Torino Ospedale S. Giovanni Battista Direttore: Prof. Mauro Rinaldi Minimally invasive aortic valve surgery: new solutions to old problems. Prof. Mauro
More informationReconstruction of the intervalvular fibrous body during aortic and
Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: An analysis of clinical outcomes Nilto C. De Oliveira, MD Tirone E. David, MD Susan Armstrong, MSc Joan Ivanov,
More information