“Simultaneous robotic-assisted mitral valve repair and percutaneous coronary intervention.”
Adams, C., R. S. McClure, et al. (2010).
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery5(5): 375-377.
We present a case report of a robotic-assisted mitral valve repair with simultaneous percutaneous coronary intervention. A 58-year-old man presented with New York Heart Association class III symptoms from severe mitral regurgitation and significant stenosis of the right coronary artery. In a hybrid operating theater, the patient underwent placement of a bare metal stent in the right coronary artery followed immediately by robotic-assisted mitral valve repair. Both procedures were successful and occurred in a timely fashion. The patient experienced no immediate postoperative complications and was discharged home on postoperative day 5. At 2-week follow-up, he had returned to his normal activities of daily living and at 1 year remained asymptomatic. This case report demonstrates the benefits of minimally invasive robotic mitral valve repair in allowing for successful repair, early postoperative return to activity, minimal incision pain, and high patient satisfaction. It further highlights the potential benefit of a hybrid operating theater in allowing surgical and percutaneous coronary intervention procedures to be delivered in a safe and efficient manner. Copyright © 2010 by the International Society for Minimally Invasive Cardiothoracic Surgery.
“Robotic coronary artery bypass for aberrant right coronary artery stenosis.”
Chen, K. C. J., P. Teefy, et al. (2010).
Canadian Journal of Cardiology26(8).
Anomalous coronary arteries that course between the aorta and pulmonary artery are subject to compressive forces and can manifest angina, myocardial infarction and sudden death. The current report presents a young, female patient who presented with a short duration of severe, rapidly progressive angina despite optimal medical therapy. Combined computed tomography and myocardial perfusion scanning identified an anomalous dominant right coronary artery that appeared kinked at its origin between the aorta and main pulmonary artery. A robot-assisted right internal thoracic artery to right coronary artery bypass was performed, which was confirmed to be widely patent (FitzGibbon grade A) on routine intraoperative angiography. The procedure completely resolved the patient’s angina symptoms. ©2010 Pulsus Group Inc. All rights reserved.
“Predicting target vessel location for improved planning of robot-assisted CABG procedures.”
Cho, D. S., C. A. Linte, et al. (2010).
Medical image computing and computer-assisted intervention : MICCAI … International Conference on Medical Image Computing and Computer-Assisted Intervention13(Pt 3): 205-212.
Prior to performing a robot-assisted coronary artery bypass grafting procedure, a pre-operative computed tomography scan is used to assess patient candidacy and to identify the location of the target vessel. The surgeon then determines the optimal port locations to ensure proper reach to the target with the robotic instruments, while assuming that the heart does not undergo any significant changes between the pre- and intra-operative stages. However, the peri-operative workflow itself leads to changes in heart position and consequently the intra-operative target vessel location. As such, the pre-operative plan must be adequately updated to adjust the target vessel location to better suit the intraoperative condition. Here we propose a technique to predict the position of the peri-operative target vessel location with approximately 3.5 mm RMS accuracy. We believe this technique will potentially reduce the rate of conversion of robot-assisted procedures to traditional open-chest surgery due to poor planning.
“Less-invasive mitral valve operations: Trends and outcomes from the society of thoracic surgeons adult cardiac surgery database.”
Gammie, J. S., Y. Zhao, et al. (2010).
Annals of Thoracic Surgery90(5): 1401-1408.
Background: The purpose of this study was to examine utilization and outcomes of less-invasive mitral valve (LIMV) operations in North America. Methods: Between 2004 and 2008, 28,143 patients undergoing isolated mitral valve (MV) operations were identified in The Society of Thoracic Surgeons Adult Cardiac Surgical Database (STS ACSD). The LIMV operations were defined as those performed with femoral arterial and venous cannulation. Results: The LIMV operations increased from 11.9% of MV operations in 2004 to 20.1% in 2008 (p < 0.0001). In 2008, 26% of STS ACSD centers performed at least one LIMV operation, with a median of 3 per year. Patients in the LIMV group were younger and had fewer comorbidities. Median perfusion (135 versus 108 minutes) and cross-clamp times (100 versus 80 minutes, p < 0.0001) were longer in the LIMV group. Mitral valve repair rates were higher in the LIMV group (85% versus 67%, p < 0.0001). Adjusted operative mortality was similar (odds ratio 1.13, 95% confidence interval: 0.84 to 1.51, p = 0.47). Blood transfusion was less common (odds ratio 0.86, 95% confidence interval: 0.76 to 0.97, p < 0.0001) while stroke was more common (OR 1.96, 95% confidence interval: 1.46 to 2.63, p < 0.0001) in the LIMV group. Conclusions: In selected patients, LIMV operations can be performed with equivalent operative mortality, shorter hospital stay, fewer blood transfusions, and higher rates of MV repair than conventional sternotomy. However, perfusion and cross-clamp times were longer, and the risk of stroke was significantly higher. Beating- or fibrillating-heart LIMV techniques are associated with particularly high risks for perioperative stroke. © 2010 The Society of Thoracic Surgeons.
“Minimally invasive versus sternotomy approach for mitral valve surgery: A propensity analysis.”
Iribarne, A., M. J. Russo, et al. (2010).
Annals of Thoracic Surgery90(5): 1471-1477.
Background: Over the past decade, minimally invasive (MI) mitral valve surgery has grown in popularity. The purpose of this study was to compare both short- and long-term outcomes of mitral valve repair and replacement performed through a MI versus traditional sternotomy (ST) incision using a propensity analysis approach to account for differences in baseline risk. Methods: From January 2000 to December 2008, a total of 1,121 isolated mitral valve operations were performed at our institution (548 ST, 573 MI). Data were retrospectively collected on all patients, and a logistic regression model was created to predict selection to a MI versus ST approach. Propensity scores were then generated based on the regression model and matched pairs created using 1:1 nearest neighbor matching. There were 382 matched pairs in the analysis for a total sample size of 764, or 68.2% of the original cohort. Major outcomes of interest included cardiopulmonary bypass time, cross-clamp time, hospital length of stay, major in-hospital complications, and both short- and long-term survival. Results: Cardiopulmonary bypass time was 117.1 ± 2.0 minutes in the ST group and 139.7 ± 2.6 minutes in the MI group (p < 0.0001), and cross-clamp time was 79.6 ± 1.5 minutes in the ST group and 83.7 ± 1.9 in the MI group (p = 0.106). The average hospital length of stay was 9.81 ± 0.61 days among ST patients and 7.76 ± 0.37 days among MI patients (p = 0.0043). There was no significant difference in the frequency of major in-hospital complications between groups. The mean duration of survival follow-up was 4.2 ± 2.4 years. There was no significant difference in mortality at 30 days (p = 0.622) or 1 year (p = 0.599). In addition, there was no significant difference in long-term survival between groups (p = 0.569). Conclusions: Although minimally invasive mitral valve surgery required a slightly longer cardiopulmonary bypass time, there was no difference in cross-clamp time, morbidity, or mortality, and hospital length of stay was significantly shorter when compared with matched sternotomy control patients. © 2010 The Society of Thoracic Surgeons.
“Robot-assisted stenting of a high-grade anastomotic pulmonary artery stenosis following single lung transplantation.”
Lumsden, A. B., J. E. Anaya-Ayala, et al. (2010).
Journal of Endovascular Therapy17(5): 612-616.
Purpose: To report robot-assisted stenting of a stenosis at the pulmonary artery anastomosis following lung transplantation, a rare complication that conveys poor prognosis even after surgical correction. Technique: The technique is illustrated in a 72-year-old man with end-stage lung disease who received a left single lung transplant. On postoperative day 54, he was evaluated for recurrent dyspnea on exertion that was due to a severe stenosis at the site of the pulmonary artery anastomosis. Balloon angioplasty was performed, and a 10-mm stent was deployed, with marked clinical improvement. Fourteen months later, he presented with recurrent symptoms due to in-stent restenosis. Multiple attempts at catheterization and balloon angioplasty of the stent failed. Due to the technical difficulty involved in maneuvering the balloon while maintaining stability, it was decided to repeat the angioplasty with the assistance of a Hansen Sensei remote robotic navigation system. The robotic arm markedly enhanced stability and facilitated successful navigation of the stented site. A 16-mm-diameter Wallstent was placed through the previously placed balloon-expandable stent and postdilated. Conclusion: A remote robotic catheter navigation system was able to assist stenting of an anastomotic pulmonary artery stenosis following failure of conventional interventional techniques. © 2010 by the International Society of Endovascular Specialists.
“Complex repair of a Barlow’s valve using the da Vinci robotic surgical system.”
Masroor, S., C. Plambeck, et al. (2010).
Journal of Heart Valve Disease19(5): 593-595.
Robotic mitral valve repair is increasingly being used for mitral valve repair. However, the repair of a bileaflet prolapse (especially Barlow’s type) is difficult and not often considered suitable for a robotic-assisted approach. The case is reported of a successful robotic-assisted repair of a Barlow’s valve, including posterior leaflet resection, chordal transfer, cleft repair, construction of Gore-Tex neo-chords, bilateral commissuroplasties, and a flexible/partial annuloplasty. The total cardiopulmonary bypass and cross-clamp times were 231 and 183 min, respectively. The patient was discharged home on the third postoperative day and is doing well one year later, with no residual mitral regurgitation. © Copyright by ICR Publishers 2010.
“Robotic repair of posterior mitral valve prolapse versus conventional approaches: Potential realized.”
Mihaljevic, T., C. M. Jarrett, et al. (2010).
Journal of Thoracic and Cardiovascular Surgery.
OBJECTIVE: Robotic mitral valve repair is the least invasive approach to mitral valve repair, yet there are few data comparing its outcomes with those of conventional approaches. Therefore, we compared outcomes of robotic mitral valve repair with those of complete sternotomy, partial sternotomy, and right mini-anterolateral thoracotomy. METHODS: From January 2006 to January 2009, 759 patients with degenerative mitral valve disease and posterior leaflet prolapse underwent primary isolated mitral valve surgery by complete sternotomy (n = 114), partial sternotomy (n = 270), right mini-anterolateral thoracotomy (n = 114), or a robotic approach (n = 261). Outcomes were compared on an intent-to-treat basis using propensity-score matching. RESULTS: Mitral valve repair was achieved in all patients except 1 patient in the complete sternotomy group. In matched groups, median cardiopulmonary bypass time was 42 minutes longer for robotic than complete sternotomy, 39 minutes longer than partial sternotomy, and 11 minutes longer than right mini-anterolateral thoracotomy (P < .0001); median myocardial ischemic time was 26 minutes longer than complete sternotomy and partial sternotomy, and 16 minutes longer than right mini-anterolateral thoracotomy (P < .0001). Quality of mitral valve repair was similar among matched groups (P = .6, .2, and .1, respectively). There were no in-hospital deaths. Neurologic, pulmonary, and renal complications were similar among groups (P > .1). The robotic group had the lowest occurrences of atrial fibrillation and pleural effusion, contributing to the shortest hospital stay (median 4.2 days), 1.0, 1.6, and 0.9 days shorter than for complete sternotomy, partial sternotomy, and right mini-anterolateral thoracotomy (all P < .001), respectively. CONCLUSION: Robotic repair of posterior mitral valve leaflet prolapse is as safe and effective as conventional approaches. Technical complexity and longer operative times for robotic repair are compensated for by lesser invasiveness and shorter hospital stay.
“Simplifying robotic mitral valve repair: Minimizing sutures with intra-annular ring implantation.”
Myers, P. O., A. Panos, et al. (2010).
Journal of Thoracic and Cardiovascular Surgery140(6): 1441-1442.
“Robust 3D visual tracking for robotic-assisted cardiac interventions.”
Richa, R., A. P. Bó, et al. (2010).
Medical image computing and computer-assisted intervention : MICCAI … International Conference on Medical Image Computing and Computer-Assisted Intervention13(Pt 1): 267-274.
In the context of minimally invasive cardiac surgery, active vision-based motion compensation schemes have been proposed for mitigating problems related to physiological motion. However, robust and accurate visual tracking is a difficult task. The purpose of this paper is to present a hybrid tracker that estimates the heart surface deformation using the outputs of multiple visual tracking techniques. In the proposed method, the failure of an individual technique can be circumvented by the success of others, enabling the robust estimation of the heart surface deformation with increased spatial resolution. In addition, for coping with the absence of visual information due to motion blur or occlusions, a temporal heart motion model is incorporated as an additional support for the visual tracking task. The superior performance of the proposed technique compared to existing techniques individually is demonstrated through experiments conducted on recorded images of an in vivo minimally invasive CABG using the DaVinci robotic platform.
“Preoperative evaluation of patient anatomy to increase success of robotics-assisted bypass surgery.”
Trejos, A. L., I. Ross, et al. (2010).
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery5(5): 335-340.
Objective: Robotics-assisted endoscopic atraumatic coronary artery bypass has been shown to be effective in reducing surgical morbidity and length of hospital stay. Unfortunately, the criteria for selecting eligible patients for this procedure are still primitive. This has motivated the use of preoperative computed tomography scans to establish patient eligibility. The objective of this study is to establish which image measurements can be correlated to procedure success. Methods: A retrospective study was performed in 144 patients who underwent robotics-assisted coronary bypass surgery. After an initial set of 55 patients, preoperative computed tomography scans of the other patients were used to obtain patient specific measurements: the lateral distance between the midline of the sternum to the left anterior descending coronary artery and its depth from the skin surface, anteroposterior diameter of the thoracic cavity, and the transverse diameter of the thoracic cavity. The procedures were rated as successful if completed in a minimally invasive manner. Different combinations of the variables were evaluated and correlated with success. Results: A strong correlation was found between success rate and the ratio of the lateral distance to the transverse diameter in the female patients only (0.532, P = 0.006). A ratio of less than 0.20 significantly increased the occurrence of conversion during this procedure in female cases. Conclusions: The lateral distance of the left anterior descending coronary artery from the midline divided by the transverse thoracic width of a female patient shows a significant correlation with procedure success. No significant correlations were found for male patients. Copyright © 2010 by the International Society for Minimally Invasive Cardiothoracic Surgery.