Multicenter mitral valve study: a lateral approach using the da vinci surgical system.

OBJECTIVE: : The purpose of this study was to demonstrate the feasibility of simple to complex endoscopic robotic mitral valve repair, using a lateral approach. METHODS: : Data were retrospectively collected on 201 patients undergoing a lateral "ports only" endoscopic robotic mitral valve repair at three institutions. Techniques of aortic occlusion included the endoaortic balloon or a transthoracic clamp. The efficacy of the repair was measured intraoperatively by transesophageal echocardiogram. RESULTS: : Two hundred one patients with a mean age of 55.2 ± 14.2 were intended to undergo elective robotic mitral valve surgery. One hundred eighty-six (92.5%) were scheduled for a repair procedure and 15 (7.5%) were scheduled for replacement. The repair was accomplished in 179 of 186 (96.2%) of patients. Eight patients (4.3%) required a conversion to sternotomy incision. Seven converted patients received a mitral valve repair and one received a replacement mitral valve. Mitral valve pathology included 10% isolated anterior leaflet involvement, 43% isolated posterior leaflet involvement, and 6% bileaflet pathology, and the remaining patients had dilated annulus, chordal rupture, or elongation. One hundred seventy-nine patients (96.2%) had regurgitation grade of 0 to 1 after repair. Two patients (1%) died. Other adverse events included reoperation for valve-related complications, 2 of 201 (1%); reoperation for cardiac-related complications, 3 of 201 (1.5%); and new onset of atrial fibrillation, 35 of 201 (17.4%). CONCLUSIONS: : A lateral endoscopic robotic approach to mitral valve repair is safe, feasible, and can be performed consistently with acceptable postoperative results. Further follow-up is required to determine the long-term efficacy of this approach to robotic mitral valve repair.

Target vessel detection and coronary anastomosis assessment by intraoperative 12-MHz ultrasound.

PURPOSE: Our aim was to assess whether the left internal mammary artery, left anterior descending artery, and anastomosis could be visualized by intraoperative ultrasound for safe graft harvesting, optimal anastomotic target selection, and quality control. DESCRIPTION: In 10 patients, the left internal mammary artery, the left anterior descending artery, and the constructed anastomosis were scanned with 12-MHz epicardial ultrasound. Anastomosis quality was assessed on ultrasound and compared with surgeon score. EVALUATION: All left internal mammary arteries and left anterior descending arteries could be identified, and pathways could be followed on the ultrasound. Plaque and calcifications were detectable. Deviation from initial coronary anastomotic target was necessary in 2 of 10 patients. None of the constructed anastomoses needed revision. On the anastomotic scans, six anastomoses scored satisfactory and four scored good. CONCLUSIONS: Epicardial ultrasound was able to evaluate vessel characteristics and coronary anastomosis patency. This can lead to correction of surgical technique related problems in the operating room, possibly improving graft patency. Further advancements could make epicardial ultrasound a cost effective standard for anastomotic quality control. Applying it during robotic-assisted bypass surgery could make this procedure appropriate for more patients.

Influence of anastomotic techniques in totally endoscopic coronary artery bypass.

BACKGROUND: Beating heart totally endoscopic coronary artery bypass grafting (TECAB) utilizing a computer-enhanced telemanipulation system is a technically challenging procedure. The objective of our study was to compare two different anastomotic techniques. METHODS: Ten canine beating heart TECAB procedures were performed using Intuitive's daVinci surgical system. Left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) anastomosis was performed on all subjects. Anastomosis varied between a conventional running suture (8-0 Gore-tex) (group I) and an interrupted nitinol u-clip anastomosis (group II). On-table angiography was then performed to assess graft patency. RESULTS: While internal mammary artery (IMA) mobilization time decreased over the course of the study (p = 0.017), there was no significant difference in ischaemia time, anastomosis time or angiographic assessment between anastomotic techniques. Although operative time in group II was significantly shorter than in group I, this was likely due to the small sample size. There were no differences in anastomotic time or coronary occlusion time. There were also no significant differences in canine weight, IMA mobilization time, lipectomy/pericardiotomy, LAD identification, subxiphoid port placement, stabilizer position, or LAD dissection time between the cases performed with the conventional running suture and the cases performed with u-clips. CONCLUSION: Interrupted nitinol clip anastomosis or conventional running suture anastomoses are equally favourable in the short term when performing a TECAB procedure.

Proactive spraying against boll weevils (Coleoptera: Curculionidae) reduces insecticide applications and increases cotton yield and economic return.

The current standard practice of two to three preemptive insecticide applications at the start of pinhead (1-2-mm-diameter) squaring followed by threshold-triggered (whenever 10% of randomly selected squares have oviposition punctures) insecticide applications for boll weevil, Anthonomus grandis grandis Boheman, control does not provide a reliably positive impact on cotton, Gossypium hirsutum L., yields in subtropical conditions. This study showed that four fewer spray applications in a "proactive" approach, where spraying began at the start of large (5.5- 8-mm-diameter) square formation and continued at 7- to 8-d intervals while large squares were abundant, resulted in fewer infested squares and 46-56% more yield than the standard treatment at two locations during 2004. The combination of fewer sprays and increased yield made the proactive approach 115-130% more profitable than the standard. The proactive approach entails protection only at the crop's most vulnerable stage (large squares) that, as a source of food, accelerates boll weevil reproduction. In contrast, the standard approach protects early season small squares and later season bolls, both of which contribute less to boll weevil reproduction than large squares. Proaction is an in-season crop protection approach that can be used to increase yield in individual fields during the same season and that could be incorporated into boll weevil eradication strategy that involves later diapause sprays. Because proaction is based on an important relationship between the cotton plant and boll weevil reproduction, the tactic will probably be effective regardless of climate or region.