- Email: [email protected]
ROBOTIC VERSUS OPEN MITRAL VALVE REPAIR: A RETROSPECTIVE COMPARATIVE STUDY
S28 ORAL PRESENTATIONS
Heart, Lung and Circulation 2007;16:S13–S29
ORAL PRESENTATIONS
26–77%). Left main disease was found in 12 patients. Operation included CABG × 2 (6), CABG × 3 (14) and CABG × 4 (8). Associated procedures were aortic valve replacement (1), endarterectomy (2) and repair of aortic cannulation site (1). All CABG were done under on-pump beating heart technique. The left-internal mammary artery (LIMA) and left radial artery were used in 10 and 3, patients respectively. Average bypass time was 121.8 min. Mean postoperative CPK-MB level was 29.8 U/L. Average follow up time was 8.1 month (1–13 months). Techniques of proximal anastomosis. After selection of appropriate site at the ascending aorta, a series of 6–0 prolene sutures were placed around the area using simple interrupted mattress suture technique. An aortatomy was done with a 3.5 mm. aortatomy punch and occluded by a 4 mm Hegar dilator. Proximal side of the graft was then sutured and guided down to the aorta. Hegar dilator was removed and the proximal side was tied. Finally, the anastomosis was secured with another layer of continuous suture of 6–0 prolene. Result. There was no hospital death and no cerebrovascular complication. All patients were in NYHA functional class I and angina-free. The average of coronary blood flow measured intraoperatively were as following: LIMA–LAD (25.7 cc/min), aorta to LAD (46.1 cc/min), to diagonal (46.8 cc/min), to obtuse marginal branch (44.7 cc/min), to right coronary artery (53.1 cc/min), to posterior descending (28.5 cc/min), to posterolateral artery (22 cc/min). Discussion. We concluded from this study that nondevice, non-clamp proximal anastomosis approach can be used safely in CABG with encouraging early results. It should be considered as another alternative technique in selected group of patients. Long-term follow-up of this technique is mandatory. doi:10.1016/j.hlc.2007.02.037
Table 1. Results Summary Age Female Total operating time (min) CPB time (min) Cross-clamp time (min) Replacement Post pump MR 2/4 Ventilation time (h) ICU stay (h) Hospital stay (days)
Robotic
Sternotomy
p-value
60.4 ± 14.0 24 (28.9%) 239.0 ± 67.1 160.4 ± 44.6 122 ± 37.8 1(1.2%) 2 (2.5%) 8.3 ± 4.5 30.8 ± 25.7 6.6 ± 3.6
59.1 ± 13.5 12 (27.9%) 217.5 ± 55.7 107.3 ± 36.2 86.2 ± 29.6 9 (20.5) 3 (9%) 11.2 ± 12.4 28.5 ± 29.7 8.7 ± 4.2
0.62 NS 0.07 0.001 0.001 0.001 0.2 0.059 0.65 0.004
at one institution between August 2001 and August 2006. Both groups had prospective data collection and entry into a database. A retrospective cohort comparison was performed. Results. See Table 1. There were no significant differences in the patient demographics. The robotic cross-clamp and bypass times were significantly longer. In the robotic group mitral valve replacement was performed in 1 (1.2%) vs 9 (20.5%) sternotomy. Of those with valve repair 2 (2.5%) robotic vs 3 (9%) sternotomy had 2/4 MR. All others had 1/4 or less MR. There was one hospital death in the robotic group and none in the sternotomy group. There was a trend to a shorter ventilation time in the robotic group. The length of stay was significantly shorter in the robotic group. Discussion. Mitral valve repair can be successfully performed with the da Vinci surgical system. Operation, cross-clamp and bypass times are longer than a conventional approach. This may improve with experience. Despite longer operating times hospital recovery is quicker. The operative safety is acceptable. The study is limited by its retrospective nature. Long-term studies are needed to evaluate the durability of robotic mitral valve repairs.
ROBOTIC VERSUS OPEN MITRAL VALVE REPAIR: A RETROSPECTIVE COMPARATIVE STUDY
doi:10.1016/j.hlc.2007.02.038
Jaime Lee 1,2,3 , Randall Moshinsky 1,2,3 , Cassie Lowe 1,2,3 , Aubrey Almeida 1,2,3
TOTALLY ENDOSCOPIC CORONARY ARTERY BYPASS GRAFT (TECAB) AND MULTI-VESSELS SMALL THORACOTOMY (MVST) CABG USING DA VINCI ROBOTIC SURGICAL SYSTEM: AN EARLY EXPERIENCE AT BANGKOK HEART HOSPITAL
1 Monash University and Monash Medical Centre, Clayton, Australia 2 Epworth Hospital, Richmond, Australia 3 Monash Medical Centre, Australia
Background. Robotic assisted mitral valve repair has been performed in Australia since March 2004. Procedures are performed with peripheral cardiopulmonary bypass, aortic cross-clamp, a 5 cm right intercostal incision. The aim of this study was to compare the hospital outcomes of patients undergoing mitral valve surgery for degenerative disease via robotic and sternotomy approaches. Methods. Between March 2004 and March 2006, 84 patients with degenerative mitral valve disease underwent robotic mitral valve surgery by one team. Controls were 44 consecutive patients with degenerative disease, undergoing isolated mitral valve surgery via sternotomy
S. Banyatpiyaphod , K.V. Arom, V. Jotisakulratana, V. Pitiguagool, S. Asavapiyanond, P. Pamornsingh, C. Suwanakijboriharn, P. Ruengsakulrach, C. Vatcharasiritham Division of Cardiovascular Surgery, Bangkok Heart Hospital, Bangkok, Thailand Introduction. With the robotic technology, CABG now can be performed with a minimally invasive approach. We are sharing our experiences with totally endoscopic coronary artery bypass graft (TECAB) and multi-vessels small thoracotomy (MVST) CABG using da Vinci Robotic surgical system (Intuitive Surg., Sunnyville, CA).
Heart, Lung and Circulation 2007;16:S13–S29
ORAL PRESENTATIONS
26–77%). Left main disease was found in 12 patients. Operation included CABG × 2 (6), CABG × 3 (14) and CABG × 4 (8). Associated procedures were aortic valve replacement (1), endarterectomy (2) and repair of aortic cannulation site (1). All CABG were done under on-pump beating heart technique. The left-internal mammary artery (LIMA) and left radial artery were used in 10 and 3, patients respectively. Average bypass time was 121.8 min. Mean postoperative CPK-MB level was 29.8 U/L. Average follow up time was 8.1 month (1–13 months). Techniques of proximal anastomosis. After selection of appropriate site at the ascending aorta, a series of 6–0 prolene sutures were placed around the area using simple interrupted mattress suture technique. An aortatomy was done with a 3.5 mm. aortatomy punch and occluded by a 4 mm Hegar dilator. Proximal side of the graft was then sutured and guided down to the aorta. Hegar dilator was removed and the proximal side was tied. Finally, the anastomosis was secured with another layer of continuous suture of 6–0 prolene. Result. There was no hospital death and no cerebrovascular complication. All patients were in NYHA functional class I and angina-free. The average of coronary blood flow measured intraoperatively were as following: LIMA–LAD (25.7 cc/min), aorta to LAD (46.1 cc/min), to diagonal (46.8 cc/min), to obtuse marginal branch (44.7 cc/min), to right coronary artery (53.1 cc/min), to posterior descending (28.5 cc/min), to posterolateral artery (22 cc/min). Discussion. We concluded from this study that nondevice, non-clamp proximal anastomosis approach can be used safely in CABG with encouraging early results. It should be considered as another alternative technique in selected group of patients. Long-term follow-up of this technique is mandatory. doi:10.1016/j.hlc.2007.02.037
Table 1. Results Summary Age Female Total operating time (min) CPB time (min) Cross-clamp time (min) Replacement Post pump MR 2/4 Ventilation time (h) ICU stay (h) Hospital stay (days)
Robotic
Sternotomy
p-value
60.4 ± 14.0 24 (28.9%) 239.0 ± 67.1 160.4 ± 44.6 122 ± 37.8 1(1.2%) 2 (2.5%) 8.3 ± 4.5 30.8 ± 25.7 6.6 ± 3.6
59.1 ± 13.5 12 (27.9%) 217.5 ± 55.7 107.3 ± 36.2 86.2 ± 29.6 9 (20.5) 3 (9%) 11.2 ± 12.4 28.5 ± 29.7 8.7 ± 4.2
0.62 NS 0.07 0.001 0.001 0.001 0.2 0.059 0.65 0.004
at one institution between August 2001 and August 2006. Both groups had prospective data collection and entry into a database. A retrospective cohort comparison was performed. Results. See Table 1. There were no significant differences in the patient demographics. The robotic cross-clamp and bypass times were significantly longer. In the robotic group mitral valve replacement was performed in 1 (1.2%) vs 9 (20.5%) sternotomy. Of those with valve repair 2 (2.5%) robotic vs 3 (9%) sternotomy had 2/4 MR. All others had 1/4 or less MR. There was one hospital death in the robotic group and none in the sternotomy group. There was a trend to a shorter ventilation time in the robotic group. The length of stay was significantly shorter in the robotic group. Discussion. Mitral valve repair can be successfully performed with the da Vinci surgical system. Operation, cross-clamp and bypass times are longer than a conventional approach. This may improve with experience. Despite longer operating times hospital recovery is quicker. The operative safety is acceptable. The study is limited by its retrospective nature. Long-term studies are needed to evaluate the durability of robotic mitral valve repairs.
ROBOTIC VERSUS OPEN MITRAL VALVE REPAIR: A RETROSPECTIVE COMPARATIVE STUDY
doi:10.1016/j.hlc.2007.02.038
Jaime Lee 1,2,3 , Randall Moshinsky 1,2,3 , Cassie Lowe 1,2,3 , Aubrey Almeida 1,2,3
TOTALLY ENDOSCOPIC CORONARY ARTERY BYPASS GRAFT (TECAB) AND MULTI-VESSELS SMALL THORACOTOMY (MVST) CABG USING DA VINCI ROBOTIC SURGICAL SYSTEM: AN EARLY EXPERIENCE AT BANGKOK HEART HOSPITAL
1 Monash University and Monash Medical Centre, Clayton, Australia 2 Epworth Hospital, Richmond, Australia 3 Monash Medical Centre, Australia
Background. Robotic assisted mitral valve repair has been performed in Australia since March 2004. Procedures are performed with peripheral cardiopulmonary bypass, aortic cross-clamp, a 5 cm right intercostal incision. The aim of this study was to compare the hospital outcomes of patients undergoing mitral valve surgery for degenerative disease via robotic and sternotomy approaches. Methods. Between March 2004 and March 2006, 84 patients with degenerative mitral valve disease underwent robotic mitral valve surgery by one team. Controls were 44 consecutive patients with degenerative disease, undergoing isolated mitral valve surgery via sternotomy
S. Banyatpiyaphod , K.V. Arom, V. Jotisakulratana, V. Pitiguagool, S. Asavapiyanond, P. Pamornsingh, C. Suwanakijboriharn, P. Ruengsakulrach, C. Vatcharasiritham Division of Cardiovascular Surgery, Bangkok Heart Hospital, Bangkok, Thailand Introduction. With the robotic technology, CABG now can be performed with a minimally invasive approach. We are sharing our experiences with totally endoscopic coronary artery bypass graft (TECAB) and multi-vessels small thoracotomy (MVST) CABG using da Vinci Robotic surgical system (Intuitive Surg., Sunnyville, CA).