“Off-pump, minimally invasive and robotic coronary revascularization yield improved outcomes over traditional on-pump CABG.”
Atluri, P., E. D. Kozin, et al. (2009).
The international journal of medical robotics + computer assisted surgery : MRCAS 5(1): 1-12.
Coronary artery disease is a global health concern, with increasing morbidity and mortality. Surgical coronary artery bypass grafting has been performed on cardiopulmonary bypass for nearly four decades, with excellent long-term durability. Beating-heart coronary surgery has been increasing in frequency in an attempt to decrease cardiopulmonary bypass-related morbidity. Furthermore, with increasing expertise and technology, minimally invasive and robotic techniques have been developed to enhance post-operative recovery, patient satisfaction and cosmesis. Several clinical trials have demonstrated decreased morbidity and more rapid recovery following off-pump, minimally invasive and robotic procedures when compared to on-pump coronary artery bypass grafts (CABGs). An equivalent extent of revascularization and medium-term anastomotic patency has been demonstrated among all approaches. Furthermore, for a large number of patients who do not have anatomy amenable to traditional coronary revascularization, adjunctive molecular therapies may provide alternative myocardial micro-revascularization.
“Case 3–2009. Robotically assisted cardiac surgery.”
Ceballos, A., M. A. Chaney, et al. (2009).
J Cardiothorac Vasc Anesth 23(3): 407-16.
“Echocardiographic measurement of mitral intertrigonal distance is an adjunct to annuloplasty ring sizing.”
Cooray, S. D., E. Tutungi, et al. (2009).
J Heart Valve Dis 18(1): 106-110.
BACKGROUND AND AIM OF THE STUDY: Annuloplasty sizing with standard valve sizers may be imprecise and difficult in minimally invasive procedures. It is hypothesized that a constant clinical conversion factor relates the echocardiographic aortic annulus diameter (AAD) and the intertrigonal distance (ITD) in patients with degenerative mitral regurgitation (MR). This may provide another method to size the annuloplasty ring required for mitral valve repair. METHODS: An observational study of 50 patients with degenerative MR undergoing robotic-assisted surgery was conducted. All patients underwent surgery between September 2005 and November 2007. The AAD at the base of the aortic leaflets was measured using intraoperative two-dimensional transesophageal echocardiography. The ITD was measured independently under direct vision during surgery. The echocardiographic ITD was then determined by dividing the AAD by 0.8, and the value for each patient compared to the corresponding surgical measurement. Agreement was assessed statistically using the Bland-Altman method. RESULTS: The limits of agreement were -3 mm (t = 2.010; 49 df; p = 0.05; 95% CI: -4 to -2 mm) to 3 mm (t = 2.010; 49 df; p = 0.05; 95% CI: 2 to 4 mm). In 86% of cases (43/50), the differences between the two methods was < or = 2 mm. CONCLUSION: In most cases of degenerative mitral valve disease the echocardiographic ITD measurement is clinically acceptable, and may serve as an adjunct to existing methods when sizing the annuloplasty ring required for repair.
“Robot for Coronary Artery Bypass Grafting: A ‘Million Dollar Coat Hanger’?”
Elefteriades, J. A. (2009).
Cardiology 114(1): 56-58.
“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.
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) years], 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/m(2)), 67 patients were overweight (BMI 25.1-30 kg/m(2)), 29 patients were obese (BMI 30.1-33.9 kg/m(2)) and 4 patients were morbidly obese (BMI>/=34 kg/m(2)). There was no correlation between BMI (1) left internal mammary artery (LIMA) takedown-time [Spearman-rank correlation coefficient (R)=0.02; p=ns], (2) lipectomy and pericardiotomy-time (R=0.042, p=n.s.), (3) total operative-time (R=-0.083: p=ns), (4) cardiopulmonary-bypass-time (R=-0.012; p=ns), (5) aortic-endoocclusion-time (R=-0.055; p=ns), (6) mechanical-ventilation-time (R=0.001, p=ns), (7) length of ICU-stay (R=0.04; p=ns), (8) length of hospital-stay (R=-0.103; p=ns, or (9) occurrence of intra- and/or 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. Keywords: Obesity; Coronary artery disease; Coronary artery bypass grafting; Endoscopic surgery; Robotic surgery.