Annals of cardiothoracic surgery最新文献

{"title":"Systematic review and meta-analysis of two decades of reported outcomes for robotic coronary artery bypass grafting.","authors":"Bridget Hwang, Justin Ren, Katherine Wang, Michael L Williams, Tristan D Yan","doi":"10.21037/acs-2023-rcabg-0191","DOIUrl":"10.21037/acs-2023-rcabg-0191","url":null,"abstract":"<p><strong>Background: </strong>Despite the well-documented safety and feasibility of robotic coronary artery bypass grafting (CABG), widespread adoption of this approach remains limited by its steep learning curve, high procedural costs and paucity of data on longer-term efficacy. This current meta-analysis aims to provide a systematic overview of the outcomes of robot-assisted CABG, with a focus on long term graft patency and freedom from major adverse cardiac and cerebrovascular events (MACCE).</p><p><strong>Methods: </strong>A systematic literature search of three electronic databases was conducted for studies reporting outcomes of robotic-assisted CABG, and were grouped based on whether patients underwent robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB), totally endoscopic coronary artery bypass (TECAB) or were mixed. Perioperative and mid-to-long term results from included studies were pooled using meta-analysis of proportion or means in a random effects model.</p><p><strong>Results: </strong>In the quantitative analysis, thirty-nine eligible studies included 6,152 patients who underwent RA-MIDCAB, 1,729 patients who underwent TECAB and 21,642 patients who underwent either form of robot-assisted CABG. A high level of heterogeneity was observed amongst baseline characteristics. Perioperative mortality and complication rates were low. Conversion rate to full sternotomy overall was less than 3.2% [95% confidence interval (CI): 2.1-5.2%, I²=39%]. At a mean follow-up duration of 5.2 years, overall graft patency was 96% for both RA-MIDCAB and TECAB, and freedom from major adverse cardiac events (MACE) or MACCE was 83.2% (95% CI: 72.0-90.4%; I²=90%) for RA-MIDCAB and 91.6% (95% CI: 86.6-94.9%; I²=76%) for TECAB.</p><p><strong>Conclusions: </strong>Robot-assisted CABG is observed to have acceptable perioperative and mid-to-long term outcomes with promising overall graft patency.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 4","pages":"311-325"},"PeriodicalIF":3.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11327407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999314","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 value of bilateral internal thoracic artery grafting in incomplete revascularization and advanced hybrid revascularization.","authors":"Hiroto Kitahara, Husam H Balkhy","doi":"10.21037/acs-2023-rcabg-0195","DOIUrl":"10.21037/acs-2023-rcabg-0195","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 4","pages":"379-381"},"PeriodicalIF":3.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11327415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001698","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":"Bilateral internal thoracic artery grafting in robotic beating-heart totally endoscopic coronary artery bypass: 10-year outcomes.","authors":"Sarah Nisivaco, Riya Bhasin, Hiroto Kitahara, Brooke Patel, Charocka Coleman, Kaitlyn Grady, Won Hee Oh, Husam H Balkhy","doi":"10.21037/acs-2024-rcabg-0016","DOIUrl":"10.21037/acs-2024-rcabg-0016","url":null,"abstract":"<p><strong>Background: </strong>Multi-arterial grafting (MAG) with bilateral internal thoracic arteries (BITAs) is superior to single internal thoracic artery (ITA) and veins, however, sternal wound infection (SWI) is a deterrent to using BITA, especially in diabetic and obese patients. Sternal-sparing approaches, including robotic totally endoscopic coronary artery bypass (TECAB), may mitigate this risk. We reviewed outcomes of robotic TECAB with BITA grafting.</p><p><strong>Methods: </strong>A total of 871 patients underwent robotic TECAB at our institution from 7/2013 to 4/2024. Of these, 406 patients received BITA grafts and are the subject of this review. Early and mid-term clinical outcomes were reviewed and angiographic patency in those undergoing hybrid revascularization with percutaneous coronary intervention (PCI) after TECAB. All cases were performed via a beating-heart robotic approach, with standard TECAB port placement.</p><p><strong>Results: </strong>The mean age of the cohort was 67±9 years and 16% were female. The mean Society of Thoracic Surgeons (STS) risk was 1.47%±2.2%. Thirty-nine percent were diabetic (15% insulin-dependent) and 39% had a body mass index (BMI) ≥30 kg/m². Twenty percent had an ejection fraction (EF) ≤40%. Ninety-eight percent of cases were completed off-pump and there were no conversions to sternotomy. The mean number of grafts per patient was 2.2±0.4. The mean intensive care unit (ICU) and hospital length of stay (LOS) were 1.22±0.62 and 2.44±0.83 days, respectively. Postoperative complications included atrial fibrillation in 13%, acute kidney injury (AKI) in 3.4%, return to theatre for bleeding in 0.7%, postoperative myocardial infarction (MI) in 0.2%, and stroke in 0.2%. Thirty-day mortality was 1.2% [observed/expected (O/E): 0.89]. Return to full activities and work occurred at mean of 14±8.6 and 17±13 days, respectively. Two hundred and two patients (50%) had 'advanced' hybrid revascularization (with at least two arterial grafts and stents). ITA early graft patency in this cohort of patients was 271/278 (98%) with 100% left ITA to left anterior descending artery (LITA-LAD) patency. Mid-term follow-up was complete in all patients at mean of 51±36 months (longest follow-up at 10 years). All-cause mortality was 13% and cardiac-mortality was 2.5%. Freedom from angina was 96%, and freedom from repeat revascularization was 94%.</p><p><strong>Conclusions: </strong>Use of the beating-heart robotic TECAB approach facilitates BITA grafting to achieve multi-vessel arterial revascularization of the left coronary system, with excellent 10-year outcomes.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 4","pages":"354-363"},"PeriodicalIF":3.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11327409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999307","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":"How to perform distal anastomosis using a robotic platform: totally endoscopic coronary artery bypass.","authors":"Johannes Bonatti, Syed Faaz Ashraf, Martin Winter, Thomas E Rubino, Catalin Toma, Ibrahim Sultan","doi":"10.21037/acs-2023-rcabg-0211","DOIUrl":"10.21037/acs-2023-rcabg-0211","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 4","pages":"382-384"},"PeriodicalIF":3.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11327406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999309","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-assisted coronary artery bypass grafting: how I teach it.","authors":"Francis P Sutter, MaryAnn C Wertan, Danielle Spragan, Yoshiyuki Yamashita, Serge Sicouri","doi":"10.21037/acs-2024-rcabg-0033","DOIUrl":"10.21037/acs-2024-rcabg-0033","url":null,"abstract":"<p><p>The first robotic cardiac operation was performed more than two decades ago. This paper describes the distinct steps and components necessary for teaching robotic-assisted minimally invasive direct coronary artery bypass (R-MIDCAB). It also provides a general overview of the surgical robotic setup and ways to troubleshoot potential complications. The focus of robotic training is not only on the surgeon but includes an entire dedicated cardiac team and administrative institutional support. This team approach ensures that R-MIDCAB can be performed safely and reproducibly. Meticulous planning, incremental learning, and teamwork are the main factors leading to program success and optimal patient outcomes. Robotic-assisted internal mammary artery (IMA) harvesting and coronary revascularization via a small, anterior mini-thoracotomy has provided an alternative to sternotomy in selected patients with coronary artery disease (CAD). Benefits include less postoperative atrial fibrillation, fewer blood transfusion, less time in the operating room (OR), less ventilatory support, fewer strokes, decreased intensive care unit stay and shortened postoperative length of stay all of which manifests as a decrease in institutional resource utilization. Recent data show that R-MIDCAB and hybrid coronary revascularization provides good long-term outcomes. In addition to patient satisfaction, there is an additional overall cost benefit to R-MIDCAB over traditional sternotomy coronary artery bypass grafting (CABG), secondary to decreased hospital length of stay. Robotically harvesting the IMA, operating on a beating heart, and performing anastomoses through a small incision all require advanced training and incremental learning. Increased experience generally leads to shortened surgical times and fewer complications.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 4","pages":"346-353"},"PeriodicalIF":3.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11327414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999313","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":"Changes in aortic root dimensions post aortic root enlargement with Y-incision and modified aortotomy.","authors":"William Truesdell, Corina Ghita, China Green, Heather Knauer, Bo Yang, Nicholas S Burris","doi":"10.21037/acs-2024-aae-0042","DOIUrl":"10.21037/acs-2024-aae-0042","url":null,"abstract":"<p><strong>Background: </strong>Lifetime management in aortic stenosis (AS) can be facilitated by aortic root enlargement (ARE) to improve anatomy for future valve-in-valve (ViV) procedures. A mitral valve-sparing ARE technique (\"Y-incision\") and sinotubular junction (STJ) enlargement (\"roof\" patch aortotomy) allow upsizing by 3-4 valve sizes, but quantitative analysis of changes in root anatomy is lacking.</p><p><strong>Methods: </strong>Among 78 patients who underwent ARE by Y-incision technique (± roof aortotomy closure) we identified 45 patients with high-quality pre- and post-operative computed tomography angiography (CTA) scans to allow analysis of change in aortic root dimensions. Detailed measurements of the annulus/basilar ring and sinuses were performed by an expert imager on both pre- and post-operative CTAs. The basal ring was defined as the functional annulus when a bioprosthetic valve was present.</p><p><strong>Results: </strong>Average age was 65±11 years, the majority were female (29, 64%), and 9 (20%) had undergone prior aortic valve replacement (AVR). Valve upsizing was ≥3 sizes in 41 (91%). Post-operative mean basal ring diameter was larger compared to the native annular diameter (26.3 <i>vs.</i> 25.3 mm, P<0.01) and substantially larger than prior prosthetic valve in redo AVR (25.6 <i>vs.</i> 19.3 mm, P<0.001). Diameters of the sinuses at pre-operative computed tomography (CT) increased by +7.7±2.8 [right sinuses of Valsalva (R SVS)], +6.7±3.0 [left sinuses of Valsalva (L SVS)], and +6.6±2.9 mm [non-coronary sinuses of Valsalva (N SVS)]. Mean diameter of the STJ increased to 38.3±3.7 post-operative (+8.1±3.2 mm). Left main (LM) and right coronary artery (RCA) heights decreased by -6.3±3.3 and -3.7±3.4 mm respectively due to the supra-annular position of the valve, however, the post-operative valve-to-coronary (VTC) artery distances were 6.6±2.3 and 4.9±2.0 mm, respectively.</p><p><strong>Conclusion: </strong>The Y-incision root enlargement technique significantly enlarges the sinus and STJ diameters by 6-7 mm while preserving VTC distances despite upsizing by 3-4 valve sizes, resulting in post-operative anatomy that is favorable for future transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV).</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 3","pages":"266-274"},"PeriodicalIF":3.1,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11148756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260939","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":"Minimally invasive aortic valve replacement with Y-incision aortic root enlargement.","authors":"Marko T Boskovski, Mohammad Arammash, Tom C Nguyen, Elaine E Tseng","doi":"10.21037/acs-2023-aae-0160","DOIUrl":"10.21037/acs-2023-aae-0160","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 3","pages":"303-305"},"PeriodicalIF":3.1,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11148759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260971","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":"What did the transcatheter aortic valve replacement-surgical aortic valve replacement (TAVR-SAVR) trials tell us?","authors":"Marvin D Atkins, Michael J Reardon","doi":"10.21037/acs-2023-aae-0152","DOIUrl":"10.21037/acs-2023-aae-0152","url":null,"abstract":"<p><p>Two families of randomized trials comparing transcatheter aortic valve replacement (TAVR) to surgery for both the Balloon Expandable Valve and the Supra Annular Self-Expanding Valve have been completed to include all surgical risk levels. The result of these trials has led to the approval of TAVR for symptomatic severe aortic stenosis without using risk level as the sole criterion. We have seen an explosion of TAVR in the US to over 98,000 commercial cases in 2022. We have also seen a rapid increase in the use of TAVR in patients less than 65 years of age. With these increases, it is important to ask if they are being driven largely by the data or just the desire for TAVR by both patients and their physicians. Heart team input is a class I indication when deciding between TAVR and surgery. For surgical members of the heart team to appropriately counsel patients, a full understanding of what the TAVR surgery trials tell us as well as what they do not is essential. In this article we will explore those questions.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 3","pages":"206-210"},"PeriodicalIF":3.1,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11148760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261049","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":"Aortic annular enlargement with Y-incision/rectangular patch.","authors":"Bo Yang","doi":"10.21037/acs-2023-aae-0151","DOIUrl":"10.21037/acs-2023-aae-0151","url":null,"abstract":"<p><p>The Y-incision/rectangular patch aortic annular enlargement (Y-incision AAE) is our go-to technique for aortic annular/root enlargement at the University of Michigan for its simplicity and effectiveness. A complete aortotomy is used for first-time surgical aortic valve replacements (SAVRs), and a partial aortotomy is frequently used in reoperative SAVR. The Y-incision is made through the left-non commissure, underneath the aortic annulus to the left and right fibrous trigones. A rectangular patch is sewn to the aorto-mitral curtain from the left fibrous trigone to the right fibrous trigone and transitioned to the aortic annulus on both sides. The enlarged aortic annulus/root is sized with the valve-shape end of the sizer, and the largest size that can touch all three nadirs of the aortic annulus with one strut facing the left-right commissure is chosen. The non-pledgetted valve sutures are placed in a non-everting suture fashion on the aortic annulus, and inside-outside-inside on the patch. The sutures at the nadir of the non-coronary sinus and left coronary sinus are tied first. The proximal ascending aorta is enlarged with a posterior longitudinal aortotomy, and the distal end of the patch is trimmed to a triangular shape to facilitate the closure of the aortotomy with the \"Roof\" technique. In the 142 consecutives cases, the median size of prosthetic valve used was 29 and upsizing was 3-4 valve sizes. Outcomes included one death, one stroke, two pacemaker implantations for complete heart block including one case of aortic valve endocarditis with Gerbode fistula, and no reoperation for post-operative bleeding. The median aortic valve mean gradient was 7 mmHg and aortic valve area was 2.4 cm² two years after SAVR. The median left ventricular mass index regression was 41% in 12-24 months in patients with moderate/severe aortic stenosis.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 3","pages":"294-302"},"PeriodicalIF":3.1,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11148751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260896","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":"Comparison of the short-term outcomes between Y-incision aortic annular enlargement and traditional aortic annular enlargement techniques.","authors":"Alexander Makkinejad, Joanna Hua, Kenneth R Hassler, Katelyn Monaghan, Karen Kim, Shinichi Fukuhara, Himanshu J Patel, Bo Yang","doi":"10.21037/acs-2023-aae-0102","DOIUrl":"10.21037/acs-2023-aae-0102","url":null,"abstract":"<p><strong>Background: </strong>The short-term efficacy and safety of the Y-incision technique of aortic annular enlargement (AAE) has been established. We aimed to determine how the short-term outcomes of the Y-incision technique compared to traditional AAE techniques.</p><p><strong>Methods: </strong>From February 2011 to June 2022, 380 patients at the University of Michigan Hospital underwent aortic valve replacement (AVR) with AAE using either traditional annular enlargement techniques (Traditional group, n=270), including Nicks [63% (171/270)], Manouguian [34% (91/270)], and others [3% (8/270)], or the Y-incision technique (Y-incision group, n=110). Propensity score matching was performed by controlling for age, sex, body surface area (BSA), hypertension, diabetes, dialysis, chronic lung disease, stroke, prior cardiac surgery, primary indication, operative status, concomitant procedures, and prosthesis type, to generate a balanced cohort of 103 pairs.</p><p><strong>Results: </strong>There were no differences in demographics, comorbidities, primary indications of the operations, or concomitant procedures between the matched groups. The median native aortic annulus diameter, measured in the operating room, was 21 mm for both groups. Median prosthesis size was 23 in the Traditional group, and 27 in the Y-incision group (P<0.001). There were no differences in perioperative complications/outcomes between the matched groups, including operative mortality, which was 3.9% (8/206) overall. Short-term survival was similar between the groups on Kaplan-Meier analysis; one-year survival was 95% in the Traditional group, and 97% in the Y-incision group (P=0.54). The Y-incision group had significantly lower mean aortic valve gradients (7 <i>vs.</i> 10 mmHg, P<0.001), larger aortic valve areas (2.2 <i>vs.</i> 1.8 cm², P=0.007), and less moderate/severe patient-prosthesis mismatch (PPM) (5.5% <i>vs.</i> 23%, P=0.039) on one-year follow-up echocardiography.</p><p><strong>Conclusions: </strong>The Y-incision technique was as safe and more effective in enlarging the aortic annulus and upsizing the prosthetic valve than the traditional techniques of AAE in AVR for small aortic annuli.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"13 3","pages":"255-265"},"PeriodicalIF":3.1,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11148761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260945","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}