The Effect of Minimally Invasive Surgery and Sternotomy on Physical Activity and Quality of Life

Moscarelli, Marco; Lorusso, Roberto; Abdullahi, Yusuf; Varone, Egidio; Marotta, Marco; Solinas, Marco; Casula, Roberto; Parlanti, Alessandra; Saglio, Giuseppe; Fattouch, Khalil; Athanasiou, Thanos

doi:10.1016/j.hlc.2020.09.936

Cited by 15 publications

(22 citation statements)

References 10 publications

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“…Furthermore, there is a higher patient’s satisfaction for cosmetics in MIMVS due to the location and size of the incision ( Figure 1 ). Minimally invasive access showed improved quality of life and faster return to daily activity compared to sternotomy in the early postoperative phase (first 3 months) [ 24 , 25 ]. The results of the Mini-Mitral Trial in the United Kingdom will soon report their findings on differences in functional outcome (for example quality of life) in the first year after surgery [ 26 ].…”

Section: Benefits and Limitations Of Minimally Invasive Accessmentioning

confidence: 99%

Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon

Kroon

Morshuis

et al. 2022

JCM

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Minimally invasive mitral valve surgery is evolving rapidly since the early 1990’s and is now increasingly adopted as the standard approach for mitral valve surgery. It has a long and challenging learning curve and there are many considerations regarding technique, planning and patient selection when starting a minimally invasive program. In the current review, we provide an overview of all considerations and the decision-making process during the learning curve.

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Section: Benefits and Limitations Of Minimally Invasive Accessmentioning

confidence: 99%

Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon

Kroon

Morshuis

et al. 2022

JCM

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“…Otherwise, it could be hard to justify a traditional open surgical operation, not least because the risk/benefit threshold may be harder to meet ( Trevis et al, 2020 ). For example, conventional open surgeries, splitting the sternum (median sternotomy) or via the ribcage (thoracotomy), have been associated with a longer initial recovery and higher incidence of overall complications/adverse events than minimally invasive approaches ( Lim et al, 2021 ; Moscarelli et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Cardiac Patch Transplantation Instruments for Robotic Minimally Invasive Cardiac Surgery: Initial Proof-of-concept Designs and Surgery in a Porcine Cadaver

et al. 2022

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Background: Damaged cardiac tissues could potentially be regenerated by transplanting bioengineered cardiac patches to the heart surface. To be fully paradigm-shifting, such patches may need to be transplanted using minimally invasive robotic cardiac surgery (not only traditional open surgery). Here, we present novel robotic designs, initial prototyping and a new surgical operation for instruments to transplant patches via robotic minimally invasive heart surgery.Methods: Robotic surgical instruments and automated control systems were designed, tested with simulation software and prototyped. Surgical proof-of-concept testing was performed on a pig cadaver.Results: Three robotic instrument designs were developed. The first (called “Claw” for the claw-like patch holder at the tip) operates on a rack and pinion mechanism. The second design (“Shell-Beak”) uses adjustable folding plates and rods with a bevel gear mechanism. The third (“HeartStamp”) utilizes a stamp platform protruding through an adjustable ring. For the HeartStamp, rods run through a cylindrical structure designed to fit a uniportal Video-Assisted Thorascopic Surgery (VATS) surgical port. Designed to work with or without a sterile sheath, the patch is pushed out by the stamp platform as it protrudes. Two instrument robotic control systems were designed, simulated in silico and one of these underwent early ‘sizing and learning’ prototyping as a proof-of-concept. To reflect real surgical conditions, surgery was run “live” and reported exactly (as-it-happened). We successfully picked up, transferred and released a patch onto the heart using the HeartStamp in a pig cadaver model.Conclusion: These world-first designs, early prototypes and a novel surgical operation pave the way for robotic instruments for automated keyhole patch transplantation to the heart. Our novel approach is presented for others to build upon free from restrictions or cost—potentially a significant moment in myocardial regeneration surgery which may open a therapeutic avenue for patients unfit for traditional open surgery.

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“…26,27 Minimally invasive mitral valve surgery may be associated with a lower risk of surgical site complications and mortality, a similar need for reoperation, faster recovery, better functional outcomes, and higher patient satisfaction rates than conventional sternotomy. [28][29][30][31][32] However, although racial disparities in the use of minimally invasive surgery have been reported for noncardiac surgery, 33 disparities in utilization of and outcomes after minimally invasive approaches for mitral valve surgery have not been examined. Our primary goal was to examine racial and ethnic disparities in the utilization and outcomes of minimally invasive mitral valve surgery.…”

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Disparities in Access to Minimally Invasive Mitral Valve Surgery

et al. 2022

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ImportanceWhether people from racial and ethnic minority groups experience disparities in access to minimally invasive mitral valve surgery (MIMVS) is not known.ObjectiveTo investigate racial and ethnic disparities in the utilization of MIMVS.Design, Setting, and ParticipantsThis cross-sectional study used data from the Society of Thoracic Surgeons Database for patients who underwent mitral valve surgery between 2014 and 2019. Statistical analysis was performed from January 24 to August 11, 2022.ExposuresPatients were categorized as non-Hispanic White, non-Hispanic Black, and Hispanic individuals.Main Outcomes and MeasuresThe association between MIMVS (vs full sternotomy) and race and ethnicity were evaluated using logistic regression.ResultsAmong the 103 753 patients undergoing mitral valve surgery (mean [SD] age, 62 [13] years; 47 886 female individuals [46.2%]), 10 404 (10.0%) were non-Hispanic Black individuals, 89 013 (85.8%) were non-Hispanic White individuals, and 4336 (4.2%) were Hispanic individuals. Non-Hispanic Black individuals were more likely to have Medicaid insurance (odds ratio [OR], 2.21; 95% CI, 1.64-2.98; P &lt; .001) and to receive care from a low-volume surgeon (OR, 4.45; 95% CI, 4.01-4.93; P &lt; .001) compared with non-Hispanic White individuals. Non-Hispanic Black individuals were less likely to undergo MIMVS (OR, 0.65; 95% CI, 0.58-0.73; P &lt; .001), whereas Hispanic individuals were not less likely to undergo MIMVS compared with non-Hispanic White individuals (OR, 1.08; 95% CI, 0.67-1.75; P = .74). Patients with commercial insurance had 2.35-fold higher odds of undergoing MIMVS (OR, 2.35; 95% CI, 2.06-2.68; P &lt; .001) than those with Medicaid insurance. Patients operated by very-high volume surgeons (300 or more cases) had 20.7-fold higher odds (OR, 20.70; 95% CI, 12.7-33.9; P &lt; .001) of undergoing MIMVS compared with patients treated by low-volume surgeons (less than 20 cases). After adjusting for patient risk, non-Hispanic Black individuals were still less likely to undergo MIMVS (adjusted OR [aOR], 0.88; 95% CI, 0.78-0.99; P = .04) and were more likely to die or experience a major complication (aOR, 1.25; 95% CI, 1.16-1.35; P &lt; .001) compared with non-Hispanic White individuals.Conclusions and RelevanceIn this cross-sectional study, non-Hispanic Black patients were less likely to undergo MIMVS and more likely to die or experience a major complication than non-Hispanic White patients. These findings suggest that efforts to reduce inequity in cardiovascular medicine may need to include increasing access to private insurance and high-volume surgeons.

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The Effect of Minimally Invasive Surgery and Sternotomy on Physical Activity and Quality of Life

Cited by 15 publications

References 10 publications

Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon

Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon

Cardiac Patch Transplantation Instruments for Robotic Minimally Invasive Cardiac Surgery: Initial Proof-of-concept Designs and Surgery in a Porcine Cadaver

Racial and Ethnic Disparities in Access to Minimally Invasive Mitral Valve Surgery

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