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Robotic-assisted minimally invasive multiple vessel coronary bypass surgery is safe and can be performed with excellent results. In this video tutorial, we present our technique for robotic-assisted minimally invasive multivessel coronary artery bypass grafting, with complete coronary revascularization via a left anterior thoracotomy and guided by preoperative computed tomography.
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Procedimientos Quirúrgicos Robotizados , Humanos , Puente de Arteria Coronaria/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Toracotomía/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to investigate the outcomes of robotic mitral valve surgery with and without concomitant tricuspid valve surgery. METHODS: Patients who underwent robotic mitral surgery between March 2010 and September 2022 were included. Patients were grouped according to the presence of concomitant tricuspid interventions. The groups were compared for baseline factors, operative parameters, and early postoperative outcomes. Age- and gender-matched groups were also compared for outcomes. RESULTS: The study included 285 robotic mitral surgery patients. There were 59 patients who underwent concomitant tricuspid interventions. In the concomitant tricuspid surgery group, cardiopulmonary bypass time (150.1 vs 128.4 min, P < 0.001) and cross-clamp time (99.2 vs 82.4 min, P < 0.001) were longer. Prolonged intubation was more frequent in the concomitant tricuspid intervention group (5.2% vs 0.5%, P = 0.029). The groups did not differ in terms of mortality, permanent pacemaker (PPM) requirement, or other morbidities. Perioperative outcomes were similar after matched group analysis. CONCLUSIONS: Operative mortality and early adverse outcomes did not increase with the addition of tricuspid intervention in our cohort of robotic mitral surgery patients. The robotic approach for mitral disease and coexisting tricuspid disease may offer safe results without an increased risk of postoperative PPM requirement.
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Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Procedimientos Quirúrgicos Robotizados , Insuficiencia de la Válvula Tricúspide , Humanos , Válvula Mitral/cirugía , Válvula Tricúspide/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
OBJECTIVE: Robot-assisted minimally invasive coronary bypass surgery is one of the least invasive approaches that offers multivessel revascularization and accelerated recovery. We investigated the benefits of computed tomography angiography (CTA) guidance in robotic coronary bypass (RCAB) by analyzing perioperative outcomes. METHODS: Between April 2022 and April 2023, 60 consecutive patients who underwent RCAB under preoperative CTA guidance were included. The intercostal space of the minithoractomy incision was determined based on the distance from the thoracotomy site to the midsection of the left anterior descending artery (LAD) on preoperative CTA. Peripheral vascular findings on preoperative CTA guided the decision for the cannulation site. Perioperative parameters and early outcomes were evaluated. RESULTS: The mean age of the patients was 62.3 ± 10.5 years, and 51 patients were male (85.0%). The mean number of revascularized vessels was 2.9 ± 1.1. Left thoracotomy guided by CTA measurements was performed in the fourth intercostal space in 37 patients (61.7%) and in the third intercostal space in the remaining patients. Axillary cannulation was performed in 28 (46.7%) patients because of prohibitive findings in the iliac vessels and aorta. All target coronary arteries with an indication for bypass were revascularized with CTA-guided RCAB. The left internal mammary artery (LIMA) was anastomosed to the LAD in all patients, and the LIMA was anastomosed sequentially to the diagonal artery in 17 patients (28.3%). No operative mortality or cerebrovascular event was observed. One patient underwent reoperation due to bleeding. CONCLUSIONS: Robot-assisted minimally invasive multiple-vessel coronary bypass under preoperative CTA guidance is safe and can be performed with excellent results.
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Robótica , Humanos , Masculino , Persona de Mediana Edad , Anciano , Femenino , Puente de Arteria Coronaria/métodos , Tomografía Computarizada por Rayos X , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Toracotomía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del TratamientoRESUMEN
Objective: Red blood cell (RBC) transfusion in cardiac surgery is associated with increased morbidity and mortality. Even when using patient blood management methods, blood transfusions may still be needed in cardiac surgery. This study examined the risk factors for blood transfusion in isolated coronary artery bypass graft (CABG) surgery with a restrictive transfusion strategy, along with individualized patient blood management. Methods: We enrolled 198 patients (age, 61.8 ± 9.9 years; 28 females and 170 males) who underwent isolated CABG surgery in a single private hospital using a restrictive transfusion strategy between April 2015 and October 2020. Pre-, intra-, and postoperative parameters were compared between patients with and without RBC transfusions. The risk factors for transfusion and transfusion probability were analyzed. Results: Patients who received RBC transfusions had higher European System for Cardiac Operative Risk Evaluation values (13.60 ± 18.27%). Preoperative hematocrit (Hct) [odds ratio (OR)=0.752; 95% confidence interval (CI) 0.639-0.884; P=0.001] and female gender (OR=7.874; 95% CI 1.678-36.950; P=0.009) were significant independent risk factors for RBC transfusion in logistic regression analysis. When the preoperative Hct was 30%, the RBC transfusion probability was 61.08% in females and 16.6% in males. Patients who received RBC transfusions had longer intensive care unit (31.40 ± 25.42 hours) and hospital (11.18 ± 6.75 days) stays. Conclusion: Risk factors for RBC transfusion in isolated CABG surgery with a restrictive blood transfusion strategy were preoperative anemia and female gender.
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Achievement of complete hemostasis is a key element to success in cardiac surgery. Bleeding control is of utmost importance in minimally invasive and robotic cardiac surgery to avoid conversion, as major bleeding is one of the most common indications for conversion to sternotomy. Bleeding control with surgical techniques can be technically more difficult in robotic and minimally invasive cardiac surgery as access to the bleeding area is limited and it is harder to intervene compared with open cardiac surgery with sternotomy. We present in this case the achievement of hemostasis in a minimally invasive robotic mitral repair, without the employment of surgical techniques and with the aid of a surgical sealant.
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Background: The primary objective of this study was to evaluate the safety and feasibility of robotic-assisted mitral valve surgery without aortic cross-clamping. Methods: From January 2010 to September 2022, 28 patients underwent robotic-assisted mitral valve surgery without aortic cross-clamping in our center using DaVinci Robotic Systems. Clinical data during the perioperative period and early outcomes of the patients were recorded. Results: Most patients were in New York Heart Association (NYHA) class II and III. Mean age and EuroScore II of the patients were 71.5 ± 13.5 and 8.4 ± 3.7 respectively. The patients underwent either mitral valve replacement (n = 16, 57.1%) or mitral valve repair (n = 12, 42.9%). Concomitant procedures were performed including tricuspid valve repair, tricuspid valve replacement, PFO closure, left atrial appendage ligation, left atrial appendage thrombectomy and cryoablation for atrial fibrillation. Mean CPB times were 140.9 ± 44.6 and mean fibrillatory arrest duration was 76.6 ± 18.4. Mean duration of ICU stay was 32.5 ± 28.8â h and mean duration of hospital stay 9.8 ± 8.3 days. One patient (3.6%) underwent revision due to bleeding. New onset renal failure was observed in one (3.6%) patient and postoperative stroke in one (3.6%) patient. Postoperative early mortality was observed in two (7.1%) patients. Conclusions: Robotic-assisted mitral valve surgery without cross-clamping is a safe and feasible technique in high-risk patients undergoing redo mitral surgery with severe adhesions as well as in primary mitral valve cases that are complicated with ascending aortic calcification.
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Background: This study evaluates the clinical outcome of patients with robotic mitral valve replacement (MVR). Methods: Between January 2010 and April 2022, 117 consecutive patients underwent robotic MVR with or without additional cardiac procedures. All procedures were completed by a single surgical team with Da Vinci Robotic Systems. Perioperative variables and early clinical outcomes were recorded. Results: Mean age and EuroScore II of the patients were 57.1±12.9 and 5.1±5.7, respectively. Isolated MVR was performed in 55 (47.0%) patients and combined cardiac procedures were performed in 62 (53.0%) patients. Additional procedures included: ablation for atrial fibrillation, tricuspid valve replacement, tricuspid valve repair, left atrial appendix ligation, patent foramen ovale closure, left atrial thrombectomy and septal myectomy for hypertrophic obstructive cardiomyopathy. Mean cardiopulmonary bypass time and cross clamp time were 143±54 and 93±37 minutes, respectively. Mean intensive care unit stay time was 26.5±26.0 hours. Postoperative stroke was observed in one (0.9%) patient and new onset renal failure was observed in two (1.7%) patients. Perioperative and postoperative early mortality was observed in three (2.6%) patients, which was lower than expected. Conclusions: Robotic MVR is feasible and can be performed with good early postoperative outcomes. A majority of the patients require additional cardiac procedures.
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OBJECTIVE: Postoperative atrial fibrillation is commonly seen after cardiac surgery. One of the contributing factors is mediastinal shed blood and inflammation. Cell salvage techniques can reduce allogenic blood transfusion and reduce inflammation. The aim of this study was to investigate the reduction of postoperative atrial fibrillation by using the cell-salvage system. METHODS: Patients who underwent isolated coronary artery bypass graft surgery (n = 498) were analyzed retrospectively in 2 groups. Postoperative atrial fibrillation group (n = 75) and non-postoperative atrial fibrillation group (n = 423). Preoperative and postoperative demographic and clini- cal data were compared between the 2 groups, respectively. Postoperative atrial fibrillation and possible contributing factors were analyzed with multinomial logistic regression analysis. RESULTS: In the postoperative atrial fibrillation group, the patients' age and European System for Cardiac Operative Risk Evaluation (Euroscore) were higher than in the non-postoperative atrial fibrillation group (P = .001 and P = .003, respectively). Postoperative intensive care unit stay and hospital stay were longer in the postoperative atrial fibrillation group than in the non-postoperative atrial fibrillation group (P = .001 and P = .046, respectively). There were no statistical differences in mortality between groups. The incidence of postoperative atrial fibrillation decreased with the use of cell saver system and low Euroscore. CONCLUSION: The use of a cell salvage device intraoperatively and during the early postoperative period can decrease the incidence of postop- erative atrial fibrillation group.
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The prosthetic paravalvular leak is a rare but important complication following mitral valve replacement. Determining the location of the leak is almost always dependent on perioperative transoesophageal echocardiography and the considerable expertise of echo operators. Acoustic shadowing due to the prosthetic valve may create another important difficulty. In this report, we present a case with a paravalvular leak diagnosed 1 year after mitral valve replacement. Beating heart surgery and robotic 3D/high-resolution camera provided to localize the direct location of leak coherent with perioperative echocardiography and precise repair. The robotic approach prevented the potential complications of aortic cross-clamp and resternotomy.
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Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral , Procedimientos Quirúrgicos Robotizados , Ecocardiografía Transesofágica , Humanos , Válvula MitralRESUMEN
INTRODUCTION: There are several approaches for pericardiocentesis. However, there is no definite suggestion about puncture location after cardiac surgery. The purpose of this study is to examine whether there is any difference regarding puncture location during pericardiocentesis in postoperative cardiac tamponade comparing to nonsurgical cardiac tamponade. METHODS: We retrospectively analyzed patients who had undergone pericardiocentesis from August 2011 to December 2019. Patients were examined in two groups, nonsurgical and postsurgical, based on the etiology of pericardial tamponade. Clinical profiles, echocardiographic findings, and procedural outcomes were identified and compared. RESULTS: Sixty-eight pericardiocenteses were performed in this period. The etiology of pericardial effusion was cardiac surgery in 27 cases and nonsurgical medical conditions in 41 cases. Baseline demographic variables were similar between the surgical and nonsurgical groups. Loculated effusion was more common in the postsurgical group (48.1% vs. 4.9%, P<0.001). Maximal fluid locations were different between the groups; right ventricular location was more common in the nonsurgical group (36.6% vs. 11.1%, P=0.02), while lateral location was more common in the postsurgical group (12.2% vs. 40.7%, P=0.007). Apical drainage was more frequently performed in the postsurgical group compared to the nonsurgical group (77.8% vs. 53.7%, P=0.044). CONCLUSION: Apical approach as a puncture location can be used more frequently than subxiphoid approach for effusions occurred after cardiac surgery compared to nonsurgical effusions. Procedural success is prominent in this group and can be the first choice of treatment.
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Procedimientos Quirúrgicos Cardíacos , Taponamiento Cardíaco , Derrame Pericárdico , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Humanos , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Derrame Pericárdico/cirugía , Pericardiocentesis/efectos adversos , Estudios RetrospectivosRESUMEN
Hypertrophic obstructive cardiomyopathy requires surgical myectomy when heart failure symptoms persist despite best medical therapy. Minimally invasive myectomy with robotic surgery can be performed in experienced centers, allowing for surgical correction of accompanying mitral valve pathologies. The extent of myectomy is important to relieve left ventricular outflow tract obstruction while care should be taken to prevent iatrogenic ventricular septal defects or heart blocks caused by excessive removal of septal tissue. We report the use of intracardiac ultrasonography during robotic surgery to intraoperatively assess the myocardium before and after myectomy to increase the safety of this procedure.
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Cardiomiopatía Hipertrófica , Procedimientos Quirúrgicos Robotizados , Obstrucción del Flujo Ventricular Externo , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/cirugía , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/patología , Válvula Mitral/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Resultado del Tratamiento , Ultrasonografía , Ultrasonografía Intervencional , Obstrucción del Flujo Ventricular Externo/cirugíaRESUMEN
INTRODUCTION: Robotic valve surgery utilizes the femoral vessels to set up cardiopulmonary bypass (CPB) which translates to groin wound and lower extremity vascular complications. A less invasive technique is a totally percutaneous bypass using vascular closure devices (VCDs) with concerns for lower limb ischemia and arterial stenosis. Since April 2018, we have adopted the standard use of total percutaneous CPB in our robotic mitral cases. We report our institutional results with this technique. METHODS: All consecutive patients who underwent robotic mitral valve surgery between April 2018 and December 2020 in our institution were included in our study. Hospital database data on demographics, operative variables, and surgical outcomes were recorded and analyzed. RESULTS: Robotic mitral valve surgeries were performed on 32 consecutive patients (mean age 57.2 ± 14.8) between April 2018 and December 2020. None of our patients developed an infection at any site. Seroma, hematoma, or pseudoaneurysm were not observed at puncture sites. Surgical repair of the femoral vessels or an additional VCD was not necessary for any of our patients. Patients were followed up for a mean duration of 23.5 months. Our patients did not present with a late wound infection, a seroma, or a pseudoaneurysm, nor had complaints of limb ischemia or claudication. CONCLUSION: Total percutaneous bypass is the least invasive method of establishing extracorporeal circulation for cardiac surgery and can be performed with excellent results. The benefits of robotic surgery can be expanded with better results in groin cannulation by the adoption of total percutaneous CPB.
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Procedimientos Quirúrgicos Cardíacos , Procedimientos Quirúrgicos Robotizados , Adulto , Anciano , Puente Cardiopulmonar , Cateterismo , Ingle , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Válvula Mitral/cirugía , Estudios RetrospectivosRESUMEN
INTRODUCTION: Robotic cardiac surgery offers mitigated risks for obese patients requiring mitral valve surgery. We aimed to study the safety of robotic mitral surgery in the obese patient population by analyzing the outcomes of mitral surgery patients in our center for robotic cardiac surgery. METHOD: This study retrospectively included 123 consecutive patients who underwent robotic mitral valve operations in a single center for robotic cardiac surgery. Patients with body mass index (BMI) ≥ 30 were compared against patients with BMI < 30 for demographic and operative parameters as well as postoperative outcomes. RESULTS: Mean BMI was 33.9 ± 2.8 in the obesity group (n = 87) and 25.4 ± 2.7 in the no-obesity group (n = 36). Female gender (80.6% vs. 52.9%, p = .004), diabetes (25.0% vs. 10.3%, p = .036), and hypertension (48.6% vs. 26.4%, p = .018) were more common in patients with obesity. The obesity group was operated with similar cardiopulmonary bypass and total operative times with the no-obesity group. Postoperative drainage and blood transfusion requirements were similar between the groups. Mechanical ventilation times (6.1 ± 2.2 vs. 8.0 ± 4.4 h, p = .003) and intensive care unit stay (20.4 ± 1.6 vs. 29.4 ± 3.7, p = .027) were shorter in the obesity group. Other postoperative outcomes of infection, atrial fibrillation, hospital stay duration, and readmission rates were similar between the groups. CONCLUSION: Robotic mitral surgery is safe to perform in obese patients. Obesity should not be a contraindication for robotic mitral surgery as obese patients have outcomes similar to nonobese patients despite increased challenges and risk-factors.
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Fibrilación Atrial , Procedimientos Quirúrgicos Cardíacos , Procedimientos Quirúrgicos Robotizados , Femenino , Humanos , Tiempo de Internación , Válvula Mitral/cirugía , Obesidad/complicaciones , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND CONTEXT: Vertebral body tethering (VBT), a flexible compression-based growth modulation technique, was claimed to prevent disc degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the consequences of VBT surgery on discs and facet joints have not been precisely acknowledged. PURPOSE: The purpose of this study was to determine the changes in the intermediate and adjacent levels at least 2 years after surgery. STUDY DESIGN/SETTING: Prospectively-followed consecutive patient cohort PATIENT SAMPLE: Adolescent idiopathic scoliosis patients who underwent thoracoscopic VBT between 2014 and 2017 were included. OUTCOME MEASURES: Degeneration of the intervertebral discs using the Pfirrmann classification; Degeneration of facet joints using a scale of 0 to 3. METHODS: Demographic, perioperative, clinical, radiographic data were collected. Skeletal maturity and height gain were assessed in every follow-up. Overcorrection, tether breakage, mechanical and pulmonary complications as well as readmission and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared. RESULTS: Twenty-five patients with a mean of 38.6±10.6 months (24-62) of follow-up were included. The mean age at surgery was 12.2 (10-14), and the median Sanders stage was 3 (1-7). A mean of 7.7±1.1 (6-11) levels were tethered. The mean preoperative main thoracic curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° postoperatively, which was subsequently modulated to 12° ±11.5° during the follow-up. At the time of the MRI (mean 29±9.5 (24-62) months), the median Sanders stages was 7 (5-8). A total of 217 levels of discs and bilateral facet joints were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet scores revealed no significant differences between patients. Deterioration of previously degenerated discs was noted in one patient (from grade 2 to 3), while previously healthy lower adjacent facet joints were degenerated (grade 2) in another patient. CONCLUSIONS: Intermediate discs and facet joints were preserved after growth modulation with VBT surgery at a mean of 29 months of follow-up. Studies in larger cohorts with longer follow-up are warranted to have more in-depth analyses of the effects of relative stabilization and altered biomechanical loads.
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Degeneración del Disco Intervertebral , Disco Intervertebral , Articulación Cigapofisaria , Adolescente , Estudios de Seguimiento , Humanos , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/cirugía , Degeneración del Disco Intervertebral/diagnóstico por imagen , Degeneración del Disco Intervertebral/cirugía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Estudios Retrospectivos , Resultado del Tratamiento , Cuerpo Vertebral , Articulación Cigapofisaria/diagnóstico por imagen , Articulación Cigapofisaria/cirugíaRESUMEN
BACKGROUND: Many cardiac surgeons receive training for sternotomy-based cardiac surgical operations in residency programs and only a few education programs offer training specifically in minimally invasive cardiac surgery. In this report, we aimed to search and analyze the learning curve for robotic-assisted mitral valve (MV) repair in cardiac surgeons. METHOD: Between January 2010 and July 2019, 60 robotic-assisted isolated MV repair surgeries were performed with DaVinci Robotic Systems in our center. Different kinds of surgical techniques were used. The assessment of the learning curve was based on cardiopulmonary bypass (CPB) and transthoracic aortic clamp (CC) times. RESULT: There were 23 (38.3%) men and 37 (61.7%) women with a mean age of 48.3 years. The lesions of the MV were posterior leaflet prolapsus (n = 42, 70.0%), anterior leaflet prolapsus (n = 8, 13.3%), Barlow disease (n = 3, 5%), and annular dilatation (n = 7, 11.6%). The patients underwent notochordal implantation (n = 27, 45%), quadrangular or triangular resection (n = 23, 38.3%), isolated ring annuloplasty (n = 7, 11.7%), resection, and leaflet reduction (n = 2, 3.3%) or edge to edge repair (n = 1, 1.7%). The maturation of the learning curve appeared to be about 30 cases. The statistical analysis showed that the mean CPB and CC times for the first 30 cases were greater compared with the 30 after learning curve (155.3 vs. 118.9 min [p = .00], 102.3 vs. 80 min [p = .00], respectively). There was no case of conversion to open surgery. No perioperative mortality was observed. CONCLUSION: The maturation of the learning curve for robotic-assisted MV repair appeared to be about 30 cases in our group of patients. This study had encouraging results for surgeons who desire to start a robotic mitral surgery program.
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Procedimientos Quirúrgicos Cardíacos , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Procedimientos Quirúrgicos Robotizados , Femenino , Humanos , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: In this study, we aimed to evaluate early and longterm outcomes of both isolated or concomitant coronary artery bypass grafting with the endoscopic vein harvesting technique. METHODS: Between November 2012 and May 2017, a total of 324 patients (259 males, 65 females; mean age: 63.2±9.8 years; range, 36 to 91 years) who underwent coronary artery bypass grafting, with or without concomitant procedures, using the endoscopic vein harvesting technique were retrospectively analyzed. Early postoperative outcomes and long-term follow-up data of the patients, such as cardiovascular or cerebral events, cardiac reinterventions, and the images of coronary angiography were recorded. RESULTS: Median logistic EuroSCORE and in hospital mortality was 3.99 (0.8-81) vs. 0 .9% f or i solated c oronary surgery and 13.34 (1.5-76.4) vs. 1.5% for concomitant procedures. The long-term data could be obtained in 288 patients with a median of 59.6 (7-90) months of follow-up. During this period, 22 (7.6%) patients underwent coronary angiography for control or treatment, 12 (4.2%) patients needed revascularization, and none of the patients underwent redo coronary surgery. CONCLUSION: Our study results suggest that the endoscopic vein harvesting technique during coronary artery bypass grafting is safe in experienced hands.
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These evidence-based guidelines from the Turkish Society of Cardiovascular Surgery, National Society of Vascular and Endovascular Surgery, and Phlebology Society intend to support clinicians in best decisions regarding the treatment of venous thromboembolism (VTE). The Editor was selected by the three national societies and was tasked with the recruitment of the recognized panel. All financial support was solely derived from the sponsoring societies without the direct involvement of industry or other external stakeholders. The panel prioritized clinical questions and outcomes according to their importance for clinicians in terms of VTE. The panel agreed on 42 recommendations under 15 headings for the diagnosis, initial management, secondary prevention of VTE, and treatment of recurrent VTE events. Important recommendations included the use of ultrasonography, preference for home treatment over hospital treatment for uncomplicated VTE, preference for direct oral anticoagulants (DOACs) over vitamin K antagonists for primary treatment of cancer and non-cancer-related VTE, extended or indefinite anticoagulation with DOACs in selected high-risk patients. Early catheter-directed thrombectomy was recommended in only young symptomatic patients with a diagnosis of fresh iliofemoral deep vein thrombosis.
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BACKGROUND: The feasibility, safety and advantages of minimally invasive or robotic repair of atrial septal defect (ASD) in adults were reported previously. However, there is limited data for the application of these systems in paediatric patients. Although current robotic systems still have large instruments for surgical repair in children, some appropriate patients may benefit from this technology. METHOD: A 6-year-old child with ASD underwent robotic assistant repair via Da-Vinci Robotic Systems. Venous cannulation was achieved by internal jugular and femoral veins (10F-14F) and arterial cannulation was performed via femoral artery under transesophageal echocardiography (TEE) guidance (10F). A 3 cm incision was made in the right fourth intercostal space, used for working and the camera port in the same time. The ports were placed considering not to damage the potential developing breast tissue. After the port implantation (8F) and cardiac arrest, the ASD repair was completed with primary closure technique. RESULT: The perioperative period was uneventful and the patient was discharged from hospital 5 days after surgery. CONCLUSION: ASD closure with robotic assistant was achieved in a large enough sized paediatric patient. With the development of thinner and shorter robotic arms, it will be possible to use robotic assistance more common during the repair of congenital heart diseases.