RESUMO
We describe in detail our technique for totally endoscopic, robotic-assisted tricuspid valve repair for iatrogenic tricuspid regurgitation and biatrial cryoMAZE.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Procedimentos Cirúrgicos Robóticos , Insuficiência da Valva Tricúspide , Humanos , Valva Tricúspide/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Insuficiência da Valva Tricúspide/cirurgia , Endoscopia/métodos , Resultado do TratamentoRESUMO
In experienced hands, complex mitral valve repair can be safely and effectively performed in a totally endoscopic, robotic-assisted manner. We present a technically complex case of a 76-year-old man with severe, symptomatic mitral regurgitation due to Barlow's disease, moderate-to-severe tricuspid regurgitation, and atrial fibrillation.
Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Procedimentos Cirúrgicos Robóticos , Masculino , Humanos , Idoso , Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Resultado do Tratamento , Insuficiência da Valva Mitral/cirurgiaRESUMO
Totally endoscopic, robotic-assisted cardiac surgery has been increasingly utilized for valvular surgery. Peripheral cannulation with endoaortic balloon occlusion offers a safe approach for initiation of cardiopulmonary bypass during such procedures. We present a step-by-step demonstration of unilateral percutaneous femoral cannulation, endoaortic balloon positioning, and decannulation in a patient undergoing totally endoscopic, robotic-assisted mitral valve repair.
Assuntos
Oclusão com Balão , Procedimentos Cirúrgicos Cardíacos , Procedimentos Cirúrgicos Robóticos , Oclusão com Balão/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar , Endoscopia , Humanos , Procedimentos Cirúrgicos Robóticos/métodosRESUMO
We detail our technique for totally endoscopic, robotic-assisted mitral valve repair with the reimplantation of a ruptured papillary muscle head supported by double papillary muscle relocation and mitral annuloplasty for the treatment of nonacute ischemic mitral regurgitation.
Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Procedimentos Cirúrgicos Robóticos , Humanos , Músculos Papilares/cirurgia , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , ReimplanteRESUMO
We describe our technique for totally endoscopic, robotic-assisted tricuspid valve repair with neochords and annuloplasty in a high-risk, obese patient.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Anuloplastia da Valva Cardíaca , Implante de Prótese de Valva Cardíaca , Procedimentos Cirúrgicos Robóticos , Insuficiência da Valva Tricúspide , Humanos , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Implante de Prótese de Valva Cardíaca/métodos , Resultado do Tratamento , Anuloplastia da Valva Cardíaca/métodosRESUMO
We describe our technique for totally endoscopic, robotic-assisted thoracic and pericardial adhesiolysis and redo complex mitral valve repair.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência da Valva Mitral , Procedimentos Cirúrgicos Robóticos , Humanos , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Endoscopia/métodosRESUMO
Background: Robotic surgery has gained popularity over the past two decades due to the benefits related to smaller surgical incisions, enhanced technical dexterity and better intraoperative visualization. We present the Yale experience of the first two hundred totally endoscopic, robotic-assisted mitral valve repair procedures for the treatment of degenerative mitral regurgitation. Methods: We performed a retrospective cohort study of patients undergoing totally endoscopic, robotic-assisted isolated or concomitant mitral valve repair for degenerative mitral regurgitation at Yale-New Haven Hospital from October 2018 to April 2022. Mitral valve repair procedures for rheumatic or secondary functional mitral regurgitation and planned robotic-assisted mitral valve replacement cases were excluded. Results: Two hundred consecutive procedures were performed. The median age was 65 years (interquartile range, 58-73 years). Six patients (3.0%) had a history of mediastinal radiation, four patients (2.0%) had previous cardiac surgery, and one patient (0.5%) had cardiac dextroversion. Median cardiopulmonary bypass and aortic cross-clamp times were 122 and 79 minutes, respectively. Femoral vessel cannulation was performed percutaneously in 57 (28.5%) patients with no major access-site related complication. Aortic cross-clamping was performed with the endoaortic balloon occlusion device in 151 (75.5%) patients. No conversions to sternotomy occurred. Satisfactory repair was achieved in 100% of cases, with 184 (92.0%) and 16 (8.0%) of patients having trace/none or mild residual mitral regurgitation, respectively. Forty-two patients (21.0%) underwent concomitant Cox-maze procedure and 25 patients (12.5%) underwent concomitant tricuspid valve repair. Thirty-day mortality rate was 0.5%, with an observed-to-expected ratio of 0.53. Two patients (1.0%) underwent re-exploration for bleeding, one had early postoperative stroke (0.5%), five developed pneumothorax (2.5%) and two required dialysis for acute renal failure (1.0%). The median length of hospital stay was four days. Conclusions: Excellent short-term outcomes can be achieved in experienced centers for the treatment of degenerative mitral regurgitation with a totally endoscopic, robotic-assisted approach.
RESUMO
Papillary fibroelastoma is a rare, benign tumor that affects males more frequently than females and that tends to be diagnosed during the fifth or sixth decade of life. It tends to arise on cardiac valves, with the aortic valve being the most frequent location followed by the mitral valve, the tricuspid valve, and the pulmonary valve. We present the case of a robotic-assisted, totally endoscopic excision of a mitral valve papillary fibroelastoma.
Assuntos
Fibroelastoma Papilar Cardíaco , Fibroma , Neoplasias Cardíacas , Procedimentos Cirúrgicos Robóticos , Feminino , Fibroma/diagnóstico , Fibroma/cirurgia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Valva Mitral/cirurgiaRESUMO
Atrial septal defect accounts for 10-15% of congenital heart disease cases. Small-diameter atrial septal defects diagnosed during infancy or early adulthood are prone to spontaneous closure, whereas uncorrected, persistent moderate or large atrial septal defects can induce left-to-right shunting, which causes volume overload, heart failure, atrial arrhythmia, and/or pulmonary hypertension starting between the third and fourth decades of life. We describe in detail our technique for totally endoscopic, robotic-assisted atrial septal defect repair.
Assuntos
Comunicação Interatrial , Procedimentos Cirúrgicos Robóticos , Robótica , Adulto , Endoscopia , Comunicação Interatrial/cirurgia , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Whether there is a cardiac surgical patient population that does not incur harm from blood conservation is unknown. This study aimed to identify patient characteristics associated with patients who safely tolerate blood conservation. METHODS: We conducted a retrospective review of consecutive patients undergoing isolated coronary artery bypass graft surgery or isolated aortic valve replacement, or concomitant coronary artery bypass graft surgery and aortic valve replacement between 2011 and 2016, during which blood conservation intervention took place. Logistic regression derived from the preintervention cohort was applied to the postintervention cohort to identify patient characteristics associated with those predicted to be transfused in the preintervention era but were not in the postintervention era. RESULTS: In this series of 2,701 adult patients undergoing cardiac operations, blood conservation intervention in 2014 led to a 52% reduction in red blood cell transfusion. Between preintervention and postintervention cohorts, there was no significant difference in the measured outcomes. A regression model derived from the preintervention cohort was applied to the postintervention cohort to identify predictors of cohort that do not derive benefit from liberal transfusion. This model demonstrated such patient characteristics to be age more than 75 years (odds ratio [OR] 1.71, 95% confidence interval [CI]: 1.09 to 2.68, p = 0.033), body mass index less than 30 kg/m2 (OR 1.5, 95% CI: 1.02 to 2.20, p = 0.044), lowest intraoperative hematocrit between 22 and 25 (OR 1.77, 95% CI: 1.16 to 2.68, p < 0.001), and cardiopulmonary bypass use (OR 4.50, 95% CI: 2.25 to 9.01, p < 0.001). CONCLUSIONS: Blood conservation can successfully yield reduction in perioperative blood product use, with associated decrease in the risk of postoperative renal failure. A select patient population who may tolerate blood conservation safely was identified, and that may guide a targeted blood conservation effort.