Annals of cardiothoracic surgery最新文献

{"title":"Establishing a robotic aortic valve replacement program in Spain: growing opportunities for Europe.","authors":"Elena Sandoval, Daniel Pereda","doi":"10.21037/acs-2025-ravr-0003","DOIUrl":"https://doi.org/10.21037/acs-2025-ravr-0003","url":null,"abstract":"<p><strong>Background: </strong>The natural history of aortic valve disease commonly eventuates in percutaneous or open surgical treatment. Percutaneous treatment has been expanding its indication from high-risk patients to low- and moderate-risk patients; however, there are certain groups of patients who are not good candidates for percutaneous treatment, such as those with bicuspid valve disease or pure aortic regurgitation patients. Robotic surgery, as an evolution from traditional approaches, has been gradually expanding its indications in cardiac surgery. The use of a lateral approach, common to robotic mitral procedures, may become a valid alternative for several patients undergoing aortic valve procedures. The aim of the present study was to evaluate and discuss the characteristics, challenges and early results of a newly created robotic aortic valve replacement program.</p><p><strong>Methods: </strong>This was a retrospective study analysing prospectively collected data of all patients who have undergone robotic aortic valve replacement (RAVR) in Hospital Clínic Barcelona from December 2021 to October 2024.</p><p><strong>Results: </strong>Since December 2021, 25 consecutive patients have undergone RAVR. Sixty-eight percent of the cohort were males and the median age was 66 years [interquartile range (IQR), 58.5-71.8 years]. Severe aortic stenosis was the predominant lesion in 76% of patients, and degenerative calcification was the aetiology in 52% of patients. Median cardiopulmonary bypass time was 129 minutes (IQR, 113-145.5 minutes) and median ischemic time was 91 minutes (IQR, 78-105 minutes). Three patients required a re-exploration for bleeding, which was performed through the same approach, and one patient suffered an ischemic cerebro-vascular accident (CVA) with complete recovery. Median intensive care unit (ICU) length of stay and hospital length of stay were 1 and 4 days, respectively.</p><p><strong>Conclusions: </strong>Our initial experience shows that expanding a robotic program to include RAVR is feasible, safe, and can provide excellent clinical outcomes in selected patients.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"218-224"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic aortic valve replacement and aortic root enlargement for optimal prosthesis selection.","authors":"Ali Darehzereshki, Lawrence Wei, J Hunter Mehaffey, Goya Raikar, Vinay Badhwar","doi":"10.21037/acs-2024-ravr-0183","DOIUrl":"https://doi.org/10.21037/acs-2024-ravr-0183","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"238-240"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic endoscopic aortic valve replacement with rapid deployment valve: technique and outcomes.","authors":"Hiroto Kitahara, Sarah Nisivaco, Yazan Al Jamal, Husam H Balkhy","doi":"10.21037/acs-2025-ravr-10","DOIUrl":"https://doi.org/10.21037/acs-2025-ravr-10","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"244-246"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single incision right transaxillary robotic valve and coronary artery bypass grafting: a future therapy.","authors":"Ghulam Murtaza, Vinay Badhwar","doi":"10.21037/acs-2025-ravr-0050","DOIUrl":"https://doi.org/10.21037/acs-2025-ravr-0050","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"235-237"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral access fully robotic aortic valve replacement \"RAVR\": from novel to normal.","authors":"Ghulam Murtaza, Lawrence Wei","doi":"10.21037/acs-2025-ravr-0049","DOIUrl":"https://doi.org/10.21037/acs-2025-ravr-0049","url":null,"abstract":"<p><p>Right lateral access robotic aortic valve replacement (RAVR) may represent a significant advancement in minimally invasive cardiac surgery. This review examines RAVR's development, technical specifications, clinical outcomes, and future trajectory in cardiac surgery. Multicenter RAVR experiences have demonstrated promising results with low rates of operative mortality (0.9%), stroke (0.9%), and permanent pacemaker placement (2.9%). In propensity-matched comparisons with transcatheter aortic valve replacement (TAVR), RAVR had significantly lower rates of paravalvular leak (0.7% <i>vs.</i> 21.5%) and one-year mortality (1.4% <i>vs.</i> 12.5%). With a 3-cm working incision at the level of the anterior axillary line, the lateral access approach offers distinct advantages including improved surgical visualization, reduced tissue trauma, and standardization potential across various cardiac procedures. While learning curve considerations exist, these are minimal for experienced robotic mitral teams. RAVR programs have expanded to include implementation of complex procedures such as aortic root enlargement. As robotic systems become more prevalent and surgical expertise grows, RAVR shows promise to evolve from an innovative technique to a standard therapeutic option in aortic valve surgery. This evolution, supported by growing clinical evidence and technological advancement, positions RAVR as a potentially transformative development in cardiac surgery, offering patients the benefits of minimally invasive approaches while maintaining the durability of traditional surgical valve replacement.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"192-201"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing robotic aortic valve replacement beyond isolated therapy: a platform for multivalve therapy.","authors":"Lawrence M Wei, Vinay Badhwar","doi":"10.21037/acs-2025-ravr-12","DOIUrl":"https://doi.org/10.21037/acs-2025-ravr-12","url":null,"abstract":"<p><p>The application of robotic cardiac surgery has long been considered the pinnacle of surgical care for an isolated procedure. This has been for good reason, as the quality and reproducibility of isolated procedures like mitral valve (MV) repair and robotic-assisted, minimally invasive, direct coronary artery bypass have grown steadily across the globe with shrinking learning curves. Once a robotic team's learning curve has crested, however, additional opportunities may be explored that may include concomitant procedures. Following the core surgical principles of safety and procedural homogeneity with open operations, robotic cardiac surgery may be extended in a stepwise fashion to multi-valve operations, concomitant maze procedures, aortic root enlargement, septal myectomy, and even valve and coronary bypass operations, all via the same transaxillary working incision. We will review the development and operative techniques of concomitant procedures that may be utilized in conjunction with robotic aortic valve replacement (RAVR).</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"228-234"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic aortic valve replacement with simultaneous ventricular septal myectomy: a minimally invasive solution.","authors":"Taylor Pickering, Cody Dorton, Ali Darehzereshki, Robert L Smith, Lawrence Wei","doi":"10.21037/acs-2024-ravr-0186","DOIUrl":"https://doi.org/10.21037/acs-2024-ravr-0186","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"241-243"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral approach in robotic aortic valve replacement: optimizing visualization from the orient and down under.","authors":"Jeng-Wei Chen, Nai-Hsin Chi","doi":"10.21037/acs-2024-ravr-0184","DOIUrl":"https://doi.org/10.21037/acs-2024-ravr-0184","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"225-227"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of robotic and endoscopic combined aortic and mitral valve surgery: experience from National Taiwan University Hospital.","authors":"Ling-Yi Wei, Jen-Wei Chen, Nai-Kwan Chou, Yi-Chia Wang, Chi-Hsiang Huang, His-Yu Yu, Nai-Hsin Chi","doi":"10.21037/acs-2024-ravr-0185","DOIUrl":"https://doi.org/10.21037/acs-2024-ravr-0185","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive approaches in cardiac surgery have transformed the field by reducing surgical trauma and improving recovery outcomes. The lateral approach, using robotic and endoscopic technologies, offers superior visualization for complex procedures, such as combined aortic and mitral valve surgery. Addressing concurrent pathologies in the aortic and mitral valves increases procedural complexity, requiring precise techniques and optimal patient selection.</p><p><strong>Methods: </strong>This retrospective, single-center study evaluated adult patients who underwent robotic or endoscopic combined aortic and mitral valve surgery between January 2015 and November 2024. Data on patient demographics, perioperative details, and postoperative outcomes including complications, mortality rates, and improvements in New York Heart Association (NYHA) functional status were analyzed.</p><p><strong>Results: </strong>A total of 67 patients were included, with 8 undergoing robotic and 59 endoscopic procedures. No mortality or conversion to open surgery was observed. Postoperative complications were minimal, with a low infection rate of 1.5% and an atrial fibrillation rate of 26.8%. Over 85% of patients experienced significant improvement in NYHA functional status.</p><p><strong>Conclusions: </strong>Robotic and endoscopic combined aortic and mitral valve surgery using the lateral approach is safe and effective, yielding excellent outcomes in a well-selected patient population.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"210-217"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic aortic valve replacement in the Middle East: reproducibility into practice with evolving complexity.","authors":"Feras H Khaliel, Mohammed S Al Aboud, Faisal A Fallatah, Ali B Alenazy","doi":"10.21037/acs-2024-ravr-0195","DOIUrl":"https://doi.org/10.21037/acs-2024-ravr-0195","url":null,"abstract":"<p><strong>Background: </strong>Robotic aortic valve replacement (RAVR) has seen a rise in usage in recent years; however, follow-up data remain limited. This study aimed to assess the short- and mid-term clinical outcomes after RAVR.</p><p><strong>Methods: </strong>This study included patients who underwent RAVR between 2022 and 2024. The primary outcomes were mortality and survival at follow-up. The secondary outcomes were hospital complications and echocardiographic parameters at follow-up.</p><p><strong>Results: </strong>Fifteen patients underwent RAVR. The mean age was 38.6±14.4 years, and 86.7% were males. The median Society of Thoracic Surgery (STS) score was 0.6%. Isolated RAVR was performed in 66.7% of the patients (n=10), whereas five patients underwent concomitant surgery, including mitral valve repair (n=1), mitral valve replacement (n=3), and ascending aortoplasty (n=1). Mechanical valves were used in 10 patients (66.7%). The mean ischemic time was 150±33.9 min. No sternotomy conversion was required. The median length of hospital stay was 9 days [quartile (Q)1-Q3, 4-15 days]. Four patients had on-table extubation (26.7%). One patient required intensive care unit (ICU) readmission, and one patient was readmitted for pleural effusion. The median follow-up was 24 months (Q1-Q3, 15-29 months). No mortality was reported during this period. All patients were in New York Heart Association (NYHA) class I, except for one in NYHA II. There were no significant changes in left ventricular ejection fraction (LEVF) at the last follow-up compared with the preoperative value (P=0.741). However, the left ventricular end-diastolic diameter (LVEDD) was significantly lower at follow-up than preoperatively (P=0.003).</p><p><strong>Conclusions: </strong>RAVR demonstrates promising short- and mid-term clinical outcomes. Its minimally invasive nature and the ability to use durable mechanical valves may offer potential advantages over traditional surgical and transcatheter approaches.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 3","pages":"202-209"},"PeriodicalIF":3.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}