Annals of cardiothoracic surgery最新文献

{"title":"Australian outcomes from heart transplantation in the machine perfusion era.","authors":"Yashutosh Joshi, Campbell MacLean, Sam Emmanuel, Katherine Wang, Claudio Soto, Jeanette Villanueva, Ling Gao, Aoife Doyle, Sanjay Dutta, Jianxin Wu, Nikunj Vaidhya, Emily Granger, Alasdair Watson, Mark Connellan, Arjun Iyer, Paul Jansz, Peter Macdonald","doi":"10.21037/acs-2024-dcd-0074","DOIUrl":"10.21037/acs-2024-dcd-0074","url":null,"abstract":"<p><strong>Background: </strong>In the current era of heart transplantation, machine perfusion strategies are emerging as potential additions to the armamentarium of a transplant unit. Donation after circulatory death (DCD) donor hearts assessed through normothermic machine perfusion (NMP) has helped expand the donor pool. Hypothermic machine perfusion (HMP) is emerging as an alternative strategy to traditional static cold storage (SCS) when a prolonged ischemic time is anticipated in brain dead (BD) donors, this is important in Australia where long distant procurement is vital. In this study we examine the outcomes in our unit where both forms of machine perfusion (NMP and HMP), as well as SCS is utilized for donor heart preservation, with a particular focus on severe primary graft dysfunction (sPGD) and mortality.</p><p><strong>Methods: </strong>The year 2021 represents the year when both forms of machine perfusion were available to our unit. Heart transplants in our unit from January 2021 to February 2024 were categorized into three groups for retrospective analysis: (I) DCD-NMP group (n=44); (II) BD-HMP group (n=38), and (III) BD-SCS group (n=78).</p><p><strong>Results: </strong>There were no significant differences in the mean donor and recipient ages between the three groups. Donor preservation time in the BD-HMP group was significantly longer than the donor ischemic time in the BD-SCS group, and organ care system (OCS) run time in the DCD-NMP group (361±89 <i>vs.</i> 208±47 and 249±49 min respectively, P<0.001). For DCD-NMP, BD-HMP and BD-SCS groups respectively: 30-day survival was: 100%, 97% and 100%; 1-year survival was: 94%, 90% and 94%; 2-year survival was: 90%, 90% and 89% (P=0.9). There was no significant difference in the incidence of sPGD between the three groups (DCD-NMP: 7%, BD-HMP: 5%, and BD-SCS: 5%, P=0.9).</p><p><strong>Conclusions: </strong>Machine perfusion strategies represent important additions to the modern transplant unit and can expand the donor pool. Results are encouraging with no differences in 2-year survival or incidence of sPGD across the preservation modalities: DCD-NMP, BD-HMP, and BD-SCS.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 6","pages":"502-512"},"PeriodicalIF":3.3,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799214","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":"Developing a thoracoabdominal normothermic regional perfusion (TA-NRP) program for the recovery of organs for thoracic transplant: lessons from the United States experience.","authors":"Kyle S Bilodeau, Sarah Y Park, Elizabeth Bashian, Jason Zakko, Michael T Cain, Jessica Y Rove, T Brett Reece, Joseph C Cleveland, Jordan R H Hoffman","doi":"10.21037/acs-2024-dcd-0038","DOIUrl":"10.21037/acs-2024-dcd-0038","url":null,"abstract":"<p><strong>Background: </strong>Heart and lung transplantation remain efficacious treatments for patients with end-stage cardiopulmonary failure. However, donor shortages remain a challenge to both providers and patients. Thoracoabdominal normothermic regional perfusion (TA-NRP) has been increasingly adopted to decrease organ ischemia from circulatory death donors and therefore increase the number of organs available for transplantation. Despite initial success, data on program genesis and implementation are limited. The aim of this manuscript is to characterize essential human resources, lessons, and key considerations needed to improve TA-NRP dissemination and thus adoption.</p><p><strong>Methods: </strong>Single-center evaluation of a TA-NRP program was conducted using a retrospective cohort study design. All procurements performed using TA-NRP were included. Quantitative data were summarized. Descriptive elements of programmatic genesis, implementation, and experience were summarized using an inductive reasoning approach.</p><p><strong>Results: </strong>Thirty TA-NRP procurements were performed. The average time from incision to TA-NRP initiation was 7±2 minutes and total time on TA-NRP was 87±28 minutes. In simple regression analysis, the average total TA-NRP time was noted to increase by approximately 0.86 minutes per procurement [95% confidence interval (CI): -0.10, 1.82, P=0.08], while the average warm ischemia time was noted to decrease by approximately 0.03 minutes per procurement (95% CI: -0.13, 0.07, P=0.43). Key programmatic elements during planning and implementation were identification of key stakeholders, early communication, proactive navigation of ethical concerns, staffing and equipment needs, and development of TA-NRP algorithms for pre, intra- and post-donation phases of care.</p><p><strong>Conclusions: </strong>Development of a TA-NRP program is both feasible and easily implemented at institutions with pre-existing organ donation after circulatory death (DCD) procurement experience. Early identification of key stakeholders with frequent communication identified areas in need of expanded resources and addressed early ethical concerns, while local implementation efforts supported operationalization of existing infrastructure for TA-NRP procurements.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 6","pages":"487-494"},"PeriodicalIF":3.3,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799216","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":"The role of robotic coronary artery bypass grafting in the current practice of surgical myocardial revascularization.","authors":"Joeri Van Puyvelde, Massimo Baudo, Gianluca Torregrossa, Wouter Oosterlinck","doi":"10.21037/acs-2023-rcabg-0198","DOIUrl":"10.21037/acs-2023-rcabg-0198","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 5","pages":"439-441"},"PeriodicalIF":3.3,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456641","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":"Different styles in trocar placement in robotic-assisted beating heart coronary artery bypass grafting.","authors":"Michiel Algoet, Husam H Balkhy, Dries Dewulf, Wouter Oosterlinck","doi":"10.21037/acs-2023-rcabg-0209","DOIUrl":"10.21037/acs-2023-rcabg-0209","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 5","pages":"458-460"},"PeriodicalIF":3.3,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456631","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":"Embracing industry in the development of robotic coronary bypass grafting-the sun rises in the East.","authors":"Senne De Groote, Nora Marain, Gianluca Torregrossa, Wouter Oosterlinck","doi":"10.21037/acs-2024-rcabg-14","DOIUrl":"10.21037/acs-2024-rcabg-14","url":null,"abstract":"<p><p>The introduction of robotic surgical devices nearly two decades ago led to a significant reduction in the invasiveness of cardiac procedures. The further worldwide implementation of robotic surgical devices in cardiac surgery, especially coronary artery bypass grafting and mitral valve repair or replacement, has, however, been stalled by numerous challenges. First, there is the high complexity of the procedures that involve a significant learning curve; second, there is the significant cost of robotic surgical devices. Furthermore, significant changes in the medical device regulation have occurred in recent years, hindering further technological development and the emergence of new players on the market. Finally, clinical evidence regarding the benefits of robotic-cardiac procedures remains scarce at this time. We invited all players active in or planning to throw themselves into robotic-assisted cardiac surgery to discuss these challenges in a semi-structured interview. Two promising and ambitious companies showed interest in participating in this project: Medicaroid and SS Innovations. The main conclusions from the interview are that both companies aim (I) to launch an affordable alternative compared to the current robotic surgical devices, (II) to further develop their robotic devices based on the opinion of physicians, and (III) to engage in overcoming the steep learning curve correlated with robotic-assisted cardiac procedures.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 5","pages":"417-424"},"PeriodicalIF":3.3,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456632","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":"The outcomes of robotic-assisted coronary artery bypass grafting surgery in the Atlantic demographic-a systematic review and meta-analysis of the literature.","authors":"Ashley R Wilson-Smith, Christian J Wilson-Smith, Jemilla Strode Smith, Rowen Osborn, Winky Lo, Dominic Ng, Bridget Hwang, Justin Shaw, Benjamin T Muston, Michael L Williams, Aditya Eranki, Aashray Gupta, Lucy Manuel, Malgorzata Szpytma, Luca Borruso, Advait Pandya, David Downes","doi":"10.21037/acs-2024-rcabg-15","DOIUrl":"10.21037/acs-2024-rcabg-15","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) has significantly reduced the morbidity and mortality of patients suffering from ischemic heart disease over its six decades of practice. In recent years, minimally invasive techniques have been increasingly described and utilized, with the promise of providing patients with the same standard of care without the need for the traditional full sternotomy, and in select cases without cardiopulmonary bypass, and thus providing improved recovery metrics. The present systematic review and meta-analysis sought to determine the outcomes of all patients receiving robotic-assisted CABG in an Atlantic patient demographic.</p><p><strong>Methods: </strong>The methods for this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Four databases were searched, using appropriate search terminology. Meta-analysis using proportions or means, as appropriate, were applied, and were presented as per routine practice. Kaplan-Meier curves were digitized and aggregated using previously reported, validated techniques. Quality assessment and risk of bias of each study were assessed systematically. Patient populations were subcategorized as per established technical definitions.</p><p><strong>Results: </strong>Thirty-five studies were identified through the literature search, with three studies having subgroupings appropriate for separate analysis (yielding 42 data points maximally). A total of 9,078 patients (69% male), with a mean age of 62.3 years, were identified across the study period. On actuarial assessment, survival at yearly assessment from 1-, 2-, 3-, 4- and 5-yearly intervals was determined to be 95%, 94%, 92%, 90%, and 88%, respectively.</p><p><strong>Conclusions: </strong>The present systematic review and meta-analysis demonstrated that short-term mortality, operative time, and admission [intensive care unit (ICU) and overall length of stay] outcomes were encouraging in the Atlantic demographic. Freedom from long-term mortality assessment of a smaller cohort showed encouraging results. A major caveat to the present analysis is the high degree of heterogeneity in the reporting of data. Analysis of future randomized controlled trials will be vital in establishing these procedures as commonplace.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 5","pages":"388-396"},"PeriodicalIF":3.3,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456640","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":"Total endoscopic coronary artery bypass on a DaVinci Xi platform without an EndoWrist stabilizer combining the technology of GelPOINT Mini, AirSeal, and Octopus Nuvo.","authors":"Gianluca Torregrossa, Amanda Yakobitis, Courtney Murray, Massimo Baudo","doi":"10.21037/acs-2024-rcabg-0112","DOIUrl":"10.21037/acs-2024-rcabg-0112","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 5","pages":"461-463"},"PeriodicalIF":3.3,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456642","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":"Ten-year outcomes of hybrid coronary revascularization at a single center.","authors":"Joshua S Newman, Omar A Jarral, Michael C Kim, Derek R Brinster, Varinder P Singh, S Jacob Scheinerman, Nirav C Patel","doi":"10.21037/acs-2023-rcabg-0188","DOIUrl":"10.21037/acs-2023-rcabg-0188","url":null,"abstract":"<p><strong>Background: </strong>Hybrid coronary revascularization (HCR) is a well-established technique for treating multi-vessel coronary disease. There remains a paucity of discussion assessing the efficacy of HCR with respect to the timing of the surgical component relative to that of the percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>A retrospective review was undertaken of our prospectively collected database from January 2009 to December 2019. Of 395 HCR patients analyzed, we examined the outcomes of 109 pairs of propensity-matched patients who either underwent robotic-assisted minimally-invasive direct coronary artery bypass (MIDCAB) first, or who had PCI prior to surgery.</p><p><strong>Results: </strong>Thirty-day mortality was 0.25% (1 death) for the entire cohort. Mid-term survival for the total 'MIDCAB-first' group was 94.1% (17 deaths), not significantly different to that for the 'PCI-first' cohort (8 deaths, 92.7%), and this was also statistically comparable after propensity matching. Perioperative morbidity was not different between patient groups. Freedom from major adverse cardiac and cerebrovascular events (MACCE) and the incidence of repeat revascularization was similar between the two groups at up to 11-year follow-up. Elevated serum creatinine independently predicted increased MACCE for all patients, irrespective of the sequence of HCR revascularization employed.</p><p><strong>Conclusions: </strong>In appropriately selected patients with multi-vessel coronary disease, HCR is associated with excellent short and longer-term results, irrespective of whether the MIDCAB or PCI procedure is performed first.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 5","pages":"425-435"},"PeriodicalIF":3.3,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456639","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":"Small incisions still require great anesthesia: anesthesiology techniques to enhance recovery in robotic coronary bypass grafting.","authors":"Danny Feike Hoogma, Wouter Oosterlinck, Steffen Rex","doi":"10.21037/acs-2024-rcabg-0048","DOIUrl":"10.21037/acs-2024-rcabg-0048","url":null,"abstract":"<p><p>Robotic coronary artery bypass grafting (CABG) has emerged as a promising minimally invasive surgical technique for the treatment of coronary artery disease. This paper provides an in-depth analysis of the anesthetic management for robotic CABG. Challenges associated with robotic CABG are discussed and various anesthetic techniques, perioperative elements and pain management modalities that can contribute to enhanced patient recovery are explored.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 5","pages":"409-416"},"PeriodicalIF":3.3,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456637","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":"Step-by-step technique of robotic-assisted minimally invasive direct coronary artery bypass.","authors":"MaryAnn C Wertan, Serge Sicouri, Yoshiyuki Yamashita, Massimo Baudo, Trisha A Senss, Danielle Spragan, Gianluca Torregrossa, Francis P Sutter","doi":"10.21037/acs-2024-rcabg-0034","DOIUrl":"10.21037/acs-2024-rcabg-0034","url":null,"abstract":"<p><p>Coronary artery bypass grafting (CABG) is the treatment of choice for coronary artery disease. The traditional method of performing CABG via a full sternotomy has its drawbacks, including increased postoperative morbidity, a higher incidence of complications, and extended hospitalizations. Although minimally invasive and robotic-assisted technology offer promising alternatives, they have not gained wide acceptance, largely because of the limited amount of literature supporting hybrid and robotic-assisted CABG. Since 2005, Lankenau Heart Institute's cardiothoracic surgical team has been developing and refining for selected patients a method for coronary revascularization that involves robotic harvesting of the left internal mammary artery (LIMA) and beating heart surgery through a limited minithoracotomy. This technique precisely places the robotic endoscopic port over the target site of the left anterior descending (LAD) artery. The LIMA is harvested using the enhanced visualization and precision of the robotic platform. The robotic instruments are then removed, and the endoscopic port site is slightly enlarged to become the minithoracotomy, allowing for LIMA-to-LAD anastomosis. The other two robotic ports are used for drains, eliminating the need for additional incisions. The method has been used in over 2,850 patients. The method has been used in over 2,850 patients. This article describes in detail our standardized technique for robotic-assisted minimally invasive direct coronary artery bypass (R-MIDCAB).</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 5","pages":"442-451"},"PeriodicalIF":3.3,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456638","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}