Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery最新文献

{"title":"Minimally Invasive Mitral Valve Repair With New-Generation Annuloplasty Ring: Results From the International Prospective MANTRA Study.","authors":"Ilir Hysi, Marco Di Eusanio, Yeong-Hoon Choi, Nikolaos Bonaros, Joerg Kempfert, Cristian Baeza, Giovanni Troise, Davide Pacini, Francesco Pollari, Giuseppe Santarpino, Vincenzo Argano, Luigi Badano, Omer Dzemali","doi":"10.1177/15569845251338807","DOIUrl":"https://doi.org/10.1177/15569845251338807","url":null,"abstract":"<p><strong>Objective: </strong>To report the short-term real-word clinical and hemodynamic performance from the MANTRA study in patients undergoing minimally invasive mitral valve repair (MI-MVr) with the MEMO 4D ring (Corcym S.r.l., Saluggia, Italy).</p><p><strong>Methods: </strong>MANTRA is an ongoing prospective study, evaluating the real-life safety and performance data on Corcym devices. Clinical and echocardiographic core lab-assessed outcomes were collected preoperatively, at discharge, and at follow-up, and Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12) questionnaires were administrated preoperatively and at 30 days. This analysis focused on patients who underwent MI-MVr with the MEMO 4D semirigid annuloplasty ring.</p><p><strong>Results: </strong>Between July 2021 and October 2023, 97 patients were enrolled in 12 institutions. The mean age at surgery was 59.1 ± 11.9 years with a mean EuroSCORE II of 1.3 ± 1.3. Primary mitral regurgitation (MR) was the most common etiology. The 30-day mortality was 0%, and only 2 reoperations were reported within 30 days (2.1%). Surgery resulted in a marked improvement in patient New York Heart Association class, associated with a clinically significant increase in KCCQ-12 summary score. End-diastolic left ventricular diameter decreased from 55.06 ± 6.86 preoperatively to 50.13 ± 6.57 mm at 30-day follow-up, and left atrial volume decreased from 130.96 ± 50.04 preoperatively to 89.32 ± 39.65 mL at 30 days. Mean mitral pressure gradient was 3.156 ± 1.415 mm Hg. MR decreased significantly, with 44.6% of patients showing less than moderate MR.</p><p><strong>Conclusions: </strong>In this study, MI-MVr with MEMO 4D ring was confirmed to be safe and effective, providing good clinical short-term outcomes, improvement of patient quality of life, and good early hemodynamic performance with optimal reduction of MR severity and preservation of left ventricular function.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251338807"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Curve Analysis of Minimally Invasive Mitral Valve Repair.","authors":"Mohsyn Imran Malik, Brandon Loshusan, Michael W A Chu","doi":"10.1177/15569845251337406","DOIUrl":"https://doi.org/10.1177/15569845251337406","url":null,"abstract":"<p><strong>Objective: </strong>Previous learning curve analyses of minimally invasive mitral valve (MV) repair have focused largely on early safety outcomes without including detailed mitral repair quality outcomes. This study investigates the learning curve of minimally invasive MV repair over a 15-year experience, focused on clinical outcomes and evidence-based technical failure endpoints.</p><p><strong>Methods: </strong>All MV repair operations were performed by a single surgeon between May 2008 and February 2023. Patient data were stratified into 3 groups of tertiles. Failure endpoints were defined as postrepair residual mitral regurgitation ≥ mild and a 30-day composite outcome. Cumulative log-likelihood curves were constructed for minimally invasive MV repair using the primary outcomes as technical failure endpoints. Control limits were determined using previous analyses of the Society of Thoracic Surgeons database.</p><p><strong>Results: </strong>A total of 362 consecutive patients across 15 years were included. Across tertiles, there was a significant trend toward shorter cross-clamp time (<i>P</i> < 0.001), cardiopulmonary bypass time (<i>P</i> < 0.001), and hospital length of stay (<i>P</i> = 0.005). Learning curve analysis demonstrated crossing of the lower threshold at ~60 patients for postrepair mitral regurgitation ≥ mild and ~85 patients for the 30-day composite outcome. The mean adjusted risk scores for both primary outcomes based on a multivariable logistic model demonstrated no significant differences across tertiles.</p><p><strong>Conclusions: </strong>The estimated number of operations to achieve optimal repair outcomes and durability is ~60 to 85 patients. These data can improve the design of surgical training competencies, beyond avoidance of complications, and instead focus the learning curve on what is necessary to achieve optimal mitral repair outcomes.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251337406"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Resection of an Idiopathic Azygos Vein Aneurysm and the Diagnostic Role of Thoracic Venogram.","authors":"Kayla M Keenan, Rekha A Cherian, Frank C Lynch, Pauline H Go","doi":"10.1177/15569845251334129","DOIUrl":"https://doi.org/10.1177/15569845251334129","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251334129"},"PeriodicalIF":1.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular Aneurysm Repair Through the Left Anterior Minithoracotomy.","authors":"Oleksandr Babliak, Dmytro Babliak, Vasyl Lazoryshynets, Katerina Revenko, Yevhenii Melnyk, Oleksii Stohov","doi":"10.1177/15569845251333424","DOIUrl":"https://doi.org/10.1177/15569845251333424","url":null,"abstract":"<p><strong>Objective: </strong>To describe the technique and the results of left ventricular aneurysm (LVA) repair with simultaneous coronary artery bypass grafting (CABG) and/or mitral valve (MV) surgery through the left anterior thoracotomy.</p><p><strong>Methods: </strong>Between October 2018 and June 2024, a cohort of 40 patients underwent repair for postinfarction LVA through left anterior thoracotomy. Simultaneous procedures included CABG (40 patients, 100%) and MV surgery (15 patients, 37.5%) and were performed through the same thoracotomy incision. The mean age of the patients was 61.4 ± 11.4 years (range, 33 to 82 years), the mean body mass index was 27.9 ± 4.3 kg/m² (range, 19.9 to 35.9 kg/m²), and the mean LV ejection fraction was 29.9% ± 8.6% (range, 10% to 55%). The surgical technique in all patients included peripheral cardiopulmonary bypass, minithoracotomy in the fourth intercostal space, aortic cross-clamping, and cold blood cardioplegia.</p><p><strong>Results: </strong>Successful visualization and repair of the LVA and complete revascularization was achieved in all patients without conversion to sternotomy. The mean number of distal anastomoses per patient was 2.03 ± 1.12 (range, 1 to 5). The mean cardiopulmonary bypass time was 207 ± 51.0 min, and the mean cross-clamp time was 115.5 ± 28.7 min. The average intensive care unit stay was 2.1 ± 1.4 days (range, 1 to 8 days), and the total hospital stay was 6.8 ± 2.9 days (range, 4 to 14 days). No strokes, major complications, or hospital mortality were observed. The 30-day mortality included 1 patient.</p><p><strong>Conclusions: </strong>LVA repair (isolated or combined with simultaneous cardiac surgical procedures) through the left anterior thoracotomy is shown to be efficient and safe in our experience.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251333424"},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Outcomes After Minimally Invasive Versus Full Sternotomy Aortic Valve Replacement: Meta-Analysis of 75 Comparative Studies.","authors":"Maria Servito, Hannah Ramsay, Sarah Mann, Luca Ramelli, Angel-Luis Fernandez, Mohammad El Diasty","doi":"10.1177/15569845251335969","DOIUrl":"https://doi.org/10.1177/15569845251335969","url":null,"abstract":"<p><strong>Objective: </strong>Whether minimally invasive aortic valve replacement (MIAVR) offers an advantage over conventional AVR (CAVR) remains a matter of debate. Although some studies have suggested better postoperative outcomes with MIAVR, technical challenges and longer operative times remain major obstacles to the adoption of these techniques. In this meta-analysis, we compare the reported immediate postoperative outcomes of both approaches.</p><p><strong>Methods: </strong>Cochrane, MEDLINE, and Embase^® databases were searched from inception until January 2022 for studies reporting immediate postoperative outcomes of MIAVR and CAVR. Studies were excluded if they reported on concomitant procedures or enrolled pediatric patients. Random-effects meta-analysis was performed using the restricted maximum likelihood estimator with Hartung-Knapp adjustment.</p><p><strong>Results: </strong>The literature search yielded 3,921 articles, of which 75 were included in this meta-analysis. The most common techniques were ministernotomy and minithoracotomy. MIAVR was associated with lower 30-day mortality than CAVR (odds ratio [OR] = 0.65, 95% confidence interval [CI]: 0.54 to 0.78, I² = 0%, <i>P</i> < 0.001). The length of stay (LOS) in the hospital (standardized mean difference [SMD] = -0.44, 95% CI: -0.61 to -0.26, <i>P</i> < 0.001) and in the intensive care unit (SMD = -0.36, 95% CI: -0.57 to -0.15, <i>P</i> < 0.001) were shorter for MIAVR. Individual comparisons of ministernotomy and minithoracotomy to CAVR also yielded similar results. However, aortic cross-clamping and cardiopulmonary bypass times were longer for MIAVR.</p><p><strong>Conclusions: </strong>Our meta-analysis suggests that minimally invasive approaches to AVR may provide advantages beyond cosmesis. Despite longer operative times, MIAVR was associated with earlier recovery and shorter hospital LOS. These findings were consistent for both minithoracotomy and ministernotomy.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251335969"},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Totally Endoscopic Reverse Hybrid Coronary Revascularization: Early and Midterm Outcomes.","authors":"Yazan N AlJamal, Sarah Nisivaco, Riya Bhasin, Hiroto Kitahara, Sandeep Nathan, Husam H Balkhy","doi":"10.1177/15569845251334117","DOIUrl":"https://doi.org/10.1177/15569845251334117","url":null,"abstract":"<p><strong>Objective: </strong>Reverse hybrid coronary revascularization (RHCR) is the integration of percutaneous coronary intervention (PCI) followed by sternal-sparing coronary artery bypass grafting in patients with multivessel coronary artery disease (CAD). We sought to review our RHCR experience over a 10-year period using PCI first followed by robotic totally endoscopic coronary artery bypass (TECAB).</p><p><strong>Methods: </strong>We reviewed the indications and outcomes in patients who underwent RHCR (PCI with drug-eluting stents first, followed by TECAB).</p><p><strong>Results: </strong>From July 2013 to August 2024, 882 robotic TECAB procedures were performed at our institution. Of these, 60 patients underwent RHCR. The mean age of the patients was 66.7 ± 10 years, and 74% were male patients. The target vessel stented was the right coronary artery in 52 patients (87%), circumflex coronary artery in 10 patients (17%), and diagonal in 4 patients (7%). The average time from PCI to TECAB was 3.8 ± 1.64 months. A total of 35 patients (58%) underwent multivessel grafting, with 74% bilateral internal thoracic artery (ITA) use. The mean operative time was 253 ± 88 min, and the mean hospital length of stay was 2 ± 0.76 days. There were no conversions, perioperative strokes, or myocardial infarctions. At mean follow-up of 34 ± 27 months, cardiac-related mortality occurred in 1 patient. Freedom from major adverse cardiac or cerebrovascular events including repeat revascularization was 93%.</p><p><strong>Conclusions: </strong>RHCR is safe and feasible in selected patients with multivessel CAD. In experienced hands, stenting first followed by robotic TECAB with left ITA or bilateral ITA grafts resulted in excellent early and midterm outcomes. Further studies are warranted.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251334117"},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Robot-Assisted Versus Video-Assisted Thoracoscopic Segmentectomy: A Single-Institution Propensity-Matched Study.","authors":"Kojo Agyabeng-Dadzie, Inderpal S Sarkaria, Ernest Chan, Ian Christie, Summer Mazur, Kristine Ruppert, Neil Christie, Omar Awais, Ryan Levy, Nicholas Baker, Rajeev Dhupar, Arjun Pennathur, James D Luketich, Matthew Schuchert","doi":"10.1177/15569845251334361","DOIUrl":"https://doi.org/10.1177/15569845251334361","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies have evaluated the feasibility of robot-assisted thoracoscopic segmentectomy (RVATS) in comparison with video-assisted thoracoscopic segmentectomy (VATS). We report both short-term and long-term outcomes comparing RVATS and VATS at a single institution.</p><p><strong>Methods: </strong>This is a retrospective propensity-matched cohort study reviewing RVATS and VATS for primary non-small cell lung cancer (NSCLC) performed from 2013 to 2021 at our institution; 1:2 propensity matching was performed.</p><p><strong>Results: </strong>There were 108 patients who underwent RVATS and 370 who underwent VATS for primary lung cancer. After propensity matching, we had 2 well-matched cohorts of 102 patients in the RVATS group and 204 in the VATS group. Our data showed no significant difference in 90-day mortality, 30-day hospital readmission rate, or median number of lymph nodes between the RVATS and VATS groups. There was also no significant difference in postoperative morbidity except for pleural effusion. RVATS had a significantly greater median number of lymph node stations harvested and longer operative time. Although both groups achieved R0 resections in all patients, RVATS showed a greater negative tumor margin distance compared with VATS. There was no significant difference in disease-free survival or overall survival between the 2 groups at 3 years.</p><p><strong>Conclusions: </strong>In our experience, RVATS showed a greater number of lymph node stations harvested and greater negative tumor margin distance without compromising perioperative and oncological outcomes for segmentectomy performed for NSCLC.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251334361"},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life After Minimally Invasive Aortic Valve Replacement Surgery: A Systematic Review.","authors":"Matthew Hackney, Massimo Caputo, Gianni Angelini, Hunaid Vohra","doi":"10.1177/15569845251337405","DOIUrl":"https://doi.org/10.1177/15569845251337405","url":null,"abstract":"<p><strong>Objective: </strong>Aortic valve replacement surgery (AVR) via median sternotomy (MS) is the standard surgical intervention used for AVR. However, the minimally invasive approach is becoming more widely adopted. This review focuses on quality of life (QoL) after minimally invasive AVR (MIAVR). The aim of this review is to comprehensively analyze the current body of evidence for QoL after MIAVR. A second aim is to determine whether a conclusion can be made based on the literature to indicate whether MIAVR is more beneficial to the patient compared with MS and should be the preferred approach.</p><p><strong>Methods: </strong>A literature search was conducted in the PubMed database using relevant searches. Papers were either included or excluded based on their title. Through a cross-reference check from the papers identified by the search, further articles were identified. Initially, 375 manuscript titles and abstracts were screened, with 11 being included in this review.</p><p><strong>Results: </strong>The 11 studies comparing postoperative QoL between MIAVR and MS were comprehensively analyzed. Three studies showed no significant differences between the groups; however, 8 identified better QoL after surgery in the MIAVR group. Three studies investigated pulmonary function after MIAVR and MS, concluding that MIAVR demonstrated superior pulmonary function.</p><p><strong>Conclusions: </strong>Overall, MIAVR can be performed with acceptable postoperative QoL. However, the current literature is sparse, and it is not possible to say whether one approach is better than the other. MIAVR is certainly not inferior to MS in terms of QoL. Well-designed, randomized controlled trials are needed to draw more definitive conclusions.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251337405"},"PeriodicalIF":1.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the Bottleneck-Plug Technique for Large False Lumen Occlusion to Treat Type B Dissecting Aortic Aneurysm.","authors":"Akimasa Morisaki, Mariko Nakano, Kenta Nishiya, Goki Inno, Takumi Kawase, Yosuke Takahashi, Toshihiko Shibata","doi":"10.1177/15569845251339442","DOIUrl":"https://doi.org/10.1177/15569845251339442","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251339442"},"PeriodicalIF":1.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Minimally Invasive Left Ventricular Assist Device Insertion.","authors":"David Kaczorowski, Martin Winter, Ahmed Sedeek, Michael Massey, Harikesh Subramanian, Ibrahim Sultan, Gavin Hickey, Mary Keebler, Johannes Bonatti","doi":"10.1177/15569845251333432","DOIUrl":"https://doi.org/10.1177/15569845251333432","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251333432"},"PeriodicalIF":1.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}