“Anesthesia for robotic cardiac surgery: an amalgam of technology and skill.”
Chauhan, S. and S. Sukesan (2010).
Ann Card Anaesth 13(2): 169-175.
The surgical procedures performed with robtic assitance and the scope for its future assistance is endless. To keep pace with the developing technologies in this field it is imperative for the cardiac anesthesiologists to have aworking knowledge of these systems, recognize potential complications and formulate an anesthetic plan to provide safe patient care. Challenges posed by the use of robotic systems include, long surgical times, problems with one lung anesthesia in presence of coronary artery disease, minimally invasive percutaneous cardiopulmonary bypass management and expertise in Trans-Esophageal Echocardiography. A long list of cardiac surgeries are performed with the use of robotic assistance, and the list is continuously growing as surgical innovation crosses new boundaries. Current research in robotic cardiac surgery like beating heart off pump intracardic repair, prototype epicardial crawling device, robotic fetal techniques etc. are in the stage of animal experimentation, but holds a lot of promise in future.
“A novel running annuloplasty suture technique for robotically assisted mitral valve repair.”
Mihaljevic, T., C. M. Jarrett, et al. (2010).
Journal of Thoracic and Cardiovascular Surgery 139(5): 1343-1344.
“Thoracoscopic and robotic tricuspid valve annuloplasty with a biodegradable ring: An initial experience.”
Panos, A., P. O. Myers, et al. (2010).
Journal of Heart Valve Disease 19(2): 201-205.
Background and aim of the study: Ring annuloplasty is a technically demanding and time-consuming thoracoscopic and/or robotic surgery. The initial experience of the authors with the intra-annular Bioring tricuspid ring using a minimally invasive access is reviewed, and some modifications are proposed to adapt to the particularities of these approaches. Methods: Patients undergoing minimally invasive tricuspid annuloplasty were included prospectively between March and September 2008. The feasibility and ease of implantation were evaluated. A total of 10 patients (six females, four males) was included (eight with functional regurgitation, two with endocarditis). Six patients underwent surgery through a small anterolateral thoracotomy, and the da Vinci S robotic system was used in four cases. Results: The mean cardiopulmonary bypass and aortic cross-clamp times were 123 ±30 min and 86 ±28 min, respectively. Ring implantation was successful in all patients. There was one late death from multiple organ failure. None of the patients required reoperation. At discharge from hospital, seven patients had no or discrete tricuspid regurgitation (TR), and two had moderate TR with no tricuspid stenosis but remained stable during the follow up period. Conclusion: The biodegradable Bioring offers a simple and quick implantation which is feasible and simplified in minimally invasive approaches. © Copyright by ICR Publishers 2010.
“Current state of surgical myocardial revascularization.”
Sellke, F. W., L. M. Chu, et al. (2010).
Circulation Journal 74(6): 1031-1037.
Despite increasing competition from percutaneous interventions and other novel methods of non-surgical coronary revascularization, coronary artery bypass grafting (CABG) remains one of the most definitive and durable treatments for coronary artery disease, especially for those patients with extensive and diffuse disease. In recent years the CABG procedure itself has undergone innovation and evolution. This review article provides a brief historical perspective on the procedure, and examines the current state of modern variations including off-pump, limited-access, and robotic-assisted CABG. (Circ J 2010; 74: 1031 – 1037).
“Beating Heart Totally Endoscopic Coronary Artery Bypass.”
Srivastava, S., S. Gadasalli, et al. (2010).
Annals of Thoracic Surgery 89(6): 1873-1880.
Background: Graft patency and clinical freedom from graft failure remains a subject of investigation in beating-heart totally endoscopic coronary artery bypass. Methods: A total of 214 patients underwent successful beating-heart totally endoscopic coronary artery bypass from July 2004 to June 2007. Single-, double-, and triple-vessel beating-heart totally endoscopic coronary artery bypass was performed in 139, 68, and 7 patients, respectively. Fifty patients underwent planned hybrid revascularization. Eighty percent of patients (172 of 214) underwent computed tomography angiography or conventional angiography within 3 months from the time of surgery. On computed tomography angiography, the analysis included gross patency, stenosis within the graft, and contrast in the grafted coronary artery. A FitzGibbon score was used to analyze graft patency and anastomosis in patients undergoing conventional angiography. Clinical follow-up was done in all patients for any major adverse cardiac event in relation to the revascularized coronary arteries. Results: There was no myocardial infarction, operative mortality, or conversion to cardiopulmonary bypass. All patients who had computed tomography angiography were found to have grossly patent graft without stenosis and demonstrated opacification of the grafted coronary artery. Fifty-seven grafts were studied in 39 patients by conventional angiography postoperatively during hybrid revascularization. At the time of study, all grafts except one had FitzGibbon grade A anastomosis and Thrombolysis In Myocardial Infarction grade 3 flow. Three patients (1.4%) required reintervention at 2, 3, and 13 months after initial beating-heart totally endoscopic coronary artery bypass. Conclusions: The clinical freedom from graft failure noted in 98.6% patients appears to be excellent. Further angiographic and clinical follow-up is required to determine the long-term results. © 2010 The Society of Thoracic Surgeons.