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Robotically Assisted Repair of Partial Atrioventricular Canal Defect
... Robotic-assisted surgical platforms are the next step in the evolution of minimally invasive endoscopic procedures, and robotic surgery has become increasingly popular over the last two decades [1][2][3][4][5] . The main advantages of these systems are less pain, shorter hospital stay, faster recovery, and improved cosmesis. ...
... Robotic systems provide three-dimensional visualization and utilize long-shafted endoscopic instruments with seven degrees of freedom. These features enable minimally invasive mitral valve procedures to be performed as successfully as with conventional sternotomy but with reduced trauma, less need for blood and blood products, and shorter intensive care unit and hospital stays [4][5][6]9] . As surgeons use robotic surgical platforms for increasingly complex procedures, it is important to collate clinical data to validate the use of these methods for various surgery types and patient groups. ...
Introduction:
This study aimed to evaluate the feasibility and efficacy of robotically assisted, minimally invasive mitral valve surgery combined with left atrial reduction for mitral valve surgery and elimination of atrial fibrillation (AF).
Methods:
Eleven patients with severe mitral regurgitation, AF, and left atrial enlargement who underwent robotic, minimally invasive surgery between May 2013 and March 2018 were evaluated retrospectively. The da Vinci robotic system was used in all procedures. The patients' demographic data, electrocardiography (ECG) findings, and pre- and postoperative transthoracic echocardiography findings were analyzed. During follow up ECG was performed at postoperative 3, 6, and 12 months additionally at the 3rd month trans thoracic echocardiography was performed and functional capacity was also evaluated for all patients.
Results:
All patients underwent robotic-assisted mitral valve surgery with radiofrequency ablation and left atrial reduction. Mean age was 45.76±16.61 years; 7 patients were male and 4 were female. Preoperatively, mean left atrial volume index (LAVI) was 69.55±4.87 mL/m2, ejection fraction (EF) was 54.62±8.27%, and pulmonary artery pressure (PAP) was 45.75±9.42 mmHg. Postoperatively, in hospital evaluation LAVI decreased to 48.01±4.91 mL/m2 (P=0.008), EF to 50.63±10.13% (P>0.05), and PAP to 39.02±3.11 mmHg (P=0.012). AF was eliminated in 8 (72%) of the 11 patients at the 1st postoperative month. There were significant improvements in functional capacity and no mortality during follow-up.
Conclusion:
Left atrial reduction and radiofrequency ablation concomitant with robotically assisted minimally invasive mitral valve surgery can be performed safely and effectively to eliminate AF and prevent recurrence.
... Furthermore, robotic ASD closure is technically feasible and safe with a high success and a low complication rate. [9][10][11][12] In our study, ASD or PFO was observed in addition to mitral valve pathology in four patients and the defects were closed with primary suture or pericardial patch. All intraoperative measurements including the size of the pericardial patch should be done with a ruler. ...
Background:
In this study, we present our clinical experience and midterm results with the robotic-assisted concomitant procedures during mitral valve operations.
Methods:
Between March 2010 and February 2018, a total of 34 patients (8 males, 26 females; mean age 58.3 years; range, 34 to 78 years) who underwent robotic-assisted concomitant procedures during mitral valve surgery were retrospectively analyzed. Demographic characteristics of the patients, comorbidities, medical, and surgical histories, operative and laboratory results, electrocardiographic findings, postoperative intensive care unit and ward outcomes, and cardiac follow-up data were recorded. Atrial fibrillation-related medication use, stroke, or other thromboembolic events, and electrocardiographic reports in patients who underwent cryoablation were reviewed at three and 12 months after the operation.
Results:
A total of 76 robotic-assisted concomitant procedures were performed during mitral valve repair (n=11) or replacement (n=23) in 34 patients. These procedures were cryoablation (n=29), tricuspid valve repair (n=6), tricuspid valve replacement (n=2), left atrial appendage ligation (n=32), atrial septal defect and patent foramen ovale closure (n=5), and left atrial thrombectomy (n=2). The mean preoperative EuroSCORE values were 5.1±2.5. The mean duration of cardiopulmonary bypass and cross-clamp was 156±69.4 min and 101±42 min, respectively. Normal sinus rhythm was restored in 85% of the patients (24/28) after cryoablation and two patients (5.8%) had permanent pacemaker within a year during follow-up. There was one (2.9%) mortality in the early postoperative period due to hemorrhage related to the posterior left ventricular wall rupture. No blood product was used in 82.4% of the patients. One patient had a transient cerebral event and symptoms regressed completely within two months.
Conclusion:
Technological improvements and growing experience can decrease the suspects related to prolonged operational duration during robotic-assisted cardiac surgery. Concomitant procedures in addition to mitral valve operations can be performed with low complication rates in centers with experience of robotic surgery.
Background
Robotic surgery is an alternative to traditional and minimally invasive cardiac procedures. However, the adaption of robotics in congenital cardiac surgery has remained limited. We analyzed the early outcomes of our single-center experience in robotically assisted congenital cardiac surgery.
Methods
From May 2013 to February 2020, 242 robotic operations were done for secundum atrial septal defects (74.7%), sinus venous atrial septal defects (16.1%), partial anomalous pulmonary venous connections (10.7%), widely-patent foramen ovale (3.7%), ostium primum defects (2.5%), unroofed coronary sinus (1.2%), partial atrioventricular canal defects (2.5%), residual septal defects after failed percutaneous closure (1.2%) ventricular septal defect (0.4%), Cor triatriatum sinister (0.4%), subvalvular aortic stenosis (0.4%), common atrium (0.4%), and double-chambered right ventricle (0.4%) using the da Vinci system.
Results
There was no mortality. Mean age was 30.9±12.1 years, and 132 (54.5%) patients were female. Thirty (12.3%) patients were pediatric (median: 16 years, range: 12 to 17 years). Mean cardiopulmonary bypass and aortic clamping times were 89.5±30.0 and 44.9±22.3 minutes, respectively. We noted a steady decrease in operation times during the first year. Conversion to larger thoracic incisions was needed in 2 (0.8%) patients. The postoperative rates of stroke, cardiac events, pulmonary complications, and re-exploration were 0.4%, 2.4%, 4.1% and 0.8%, respectively. Mean hospital stay was 3.5±1.1 days.
Conclusions
Robotic technology can be utilized to perform suitable congenital cardiac procedures safely and effectively. With acceptable complication rates, robotic surgery can be an alternative to traditional, minimally invasive, and endoscopic approaches in adolescent and adult patients.
Robotic minimally invasive direct coronary artery bypass is the most common robotic coronary procedure performed worldwide. It can be used to treat isolated left anterior descending (LAD) stenosis or can be coupled with percutaneous coronary intervention to diseased non-LAD targets in patients with multivessel disease. Virtually all types of mitral valve repair can be performed using the robot; valve replacement can also be undertaken. The robot can be used to repair atrial septal defects and resect cardiac myxoma. Increased cost of the robotic procedure may be offset by fewer perioperative complications, shorter hospital stay, and faster postoperative recovery.
Complications after percutaneous atrial septal defect closure such as residual shunting or device-related events are generally treated using conventional sternotomy or thoracotomy incisions. In these cases, minimally invasive approaches including mini-sternotomy, mini-thoracotomy or endoscopic techniques can also be used in the management of complications, residual defects and concomitant procedures. However, robotic surgery is a reasonable alternative for removal of septal occluder devices and concomitant repair procedures to prevent cardiopulmonary morbidities. Herein, we report an adult, who underwent a totally endoscopic robotic removal of septal occluder device, closure of septal defect with autologous pericardial patch and tricuspid valve annuloplasty through a right atriotomy approach.
Background:
Atrioventricular septal defect (AVSD) accounts for up to 3 % of congenital cardiac defects, which is routinely repaired via median sternotomy. Minimally invasive approach such as endoscopic or robotic assisted repair for AVSD has not been reported in the literature. With the experience with robotic mitral valve surgery and congenital defect repair, we initiated robotic AVSD repair in adults.
Case presentation:
In this report, we presented three cases of successful repair of partial and intermediate AVSD by using da Vinci SI surgical system (Intuitive Surgical, Inc., Sunnyvale, CA).
Conclusions:
Totally robotic AVSD repair via right atriotomy could be safely performed in adults and it may provide superior cosmesis with the comparable surgical outcome of the repair via sternotomy.
Partial anomalous venous return from the right lung to the right atrium is a rare congenital heart anomaly in adults. We report a 20-year-old female, who presented with right partial anomalous pulmonary venous return and an associated inferior atrial septal defect. A complex repair was successfully done through a right atriotomy approach using a robotic surgical system.
Atrial septal defect is one of the most common congenital heart anomalies in adults. Patients with partial atrioventricular canal defects, previously known as ostium primum atrial septal defect, usually present at an early age, and only a few reach adulthood without surgical correction. Herein, we describe a young woman who presented with an ostium primum defect and severe symptomatic mitral and tricuspid regurgitation with paroxysmal atrial fibrillation. A complex repair was successfully done through a left atrial approach using robot-assistance.
A wealth of experience has been gained in the management of atrioventricular septal defect (AVSD) since the first complete correction of this malformation in 1955. The success of surgical therapy followed an enhanced understanding of morphology and physiology as well as major improvements in imaging of this congenital heart defect. Therapeutic success in the management of patients with AVSD has been extended to include those with associated lesions such as tetralogy of Fallot, double outlet right ventricle and relative degrees of ventricular hypoplasia. Although operative mortality is low and long-term survival is relatively good, important detrimental residual or AVSD-related complications such as left atrioventricular valve regurgitation, left ventricular outflow tract obstruction still carry significant late morbidity in a proportion of patients. This article reviews our current understanding of the morphology of this defect, aspects of diagnosis and surgical treatment options.