Robotic-Enhanced Totally Endoscopic Mitral Valve Repair and Ablative Therapy

Akpınar, Belhhan; Güden, Mustafa; Sağbaş, Ertan; Sanisoglu, Ilhan; Çaynak, Barış; Bayramoğlu, Zehra

doi:10.1016/j.athoracsur.2005.09.027

Cited by 18 publications

(7 citation statements)

References 6 publications

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“…Most described minimally invasive surgical attempts at correcting AF have included limited lesion sets including PVI alone and have been either performed thoracoscopically or using a minithoracotomy or mini-sternotomy. 24-27 We chose a RMT approach because it allowed us access to both atria while accommodating a bipolar RF clamp which has previously been shown to be the most reliable device experimentally in creating transmural lesions. 28,29 Moreover, we have strongly felt that a full biatrial lesion set offered the best long-term results.…”

Section: Discussionmentioning

confidence: 99%

A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay

Lawrance

Henn

Miller

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objectives The Cox-Maze IV has the best results for the surgical treatment of atrial fibrillation. It has been traditionally performed through sternotomy with excellent outcomes, but this has been felt to be too invasive. An alternative approach is to perform a less invasive right anterolateral minithoracotomy. This series compared these approaches at a single center in consecutive patients. Methods Patients receiving Cox-Maze IV (n=356) were retrospectively reviewed from January 2002 to February 2014. Patients were stratified into two groups: right mini-thoracotomy (RMT: n=104) and sternotomy (ST: n=252). Preoperative and perioperative variables were compared as well as long term outcomes. Patients were followed for up two years and rhythm was confirmed with electrocardiogram or prolonged monitoring. Results Freedom from atrial tachyarrhythmias off antiarrhythmic drugs was 81% and 74% at 1 and 2 year respectively using a RMT approach and was not significantly different from the ST group at these same time points. Overall complication rate was lower in the RMT group (6% vs. 13%, p=0.044) as was 30 day morality (0% vs. 4%, p=0.039). Median ICU length of stay was lower in the RMT group (2 days [range 0-21] vs. 3 days [range 1-61], p=0.004) as was median hospital length of stay (7 days [range 4-35] vs. 9 days [range 1-111], p<0.001). Conclusions The Cox-Maze IV performed through a right mini-thoracotomy is as effective as sternotomy in the treatment of atrial fibrillation. This approach was associated with fewer complications and decreased mortality and decreased ICU and hospital length of stays.

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Section: Discussionmentioning

confidence: 99%

A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay

Lawrance

Henn

Miller

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Consequently, many surgeons have awaited the development of a new device capable of interrupting atrial isthmus tissue safely and rapidly. The Cardioblate pen (Medtronic, Minneapolis, Minn) is an irrigated unipolar RF ablation device that allows production of spot lesions and has been used for this purpose 19. It has a unipolar electrode and results in laterally oriented heating distribution.…”

Section: Discussionmentioning

confidence: 99%

Surgical ablation for atrial fibrillation: The efficacy of a novel bipolar pen device in the cardioplegically arrested and beating heart

Sakamoto

Voeller

Melby

et al. 2008

The Journal of Thoracic and Cardiovascular Surgery

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Objective The introduction of ablation technology has simplified surgical intervention for atrial fibrillation. However, most ablation devices cannot create focal transmural lesions on the beating heart and have difficulty ablating specific regions of the atria, such as the atrioventricular isthmus, coronary sinus, and ganglionated plexus. The purpose of this study was to examine the efficacy of a pen-type bipolar radiofrequency ablation device on both arrested and beating hearts. Methods Endocardial and epicardial atrial tissues in the free wall, left atrial roof, atrioventricular annuli, and coronary sinus were ablated for varying time intervals (2.5–15 seconds) in porcine cardioplegically arrested (n = 6) and beating (n = 9) hearts. The hearts were stained with 1%2,3,5-triphenyl-tetrazolium chloride solution and sectioned to determine lesion depth and width. In 5 animals epicardial fat pads containing ganglionated plexus were stimulated and ablated. Results Lesion depth increased with ablation time similarly in both arrested and beating hearts. Transmurality was fully achieved in the thin atrial tissue (<4 mm) at 10 seconds in the beating and arrested hearts. The device had a maximal penetration depth of 6.1 mm. Epicardial ablation of the coronary sinus showed complete penetration through the left posterior atrium only in the arrested heart. Seven of 17 fat pads demonstrated a vagal response. All vagal responses were eliminated after ablation. Conclusion The bipolar pen effectively ablated atrial tissue in both arrested and beating hearts. This device might allow the surgeon to ablate tissue in regions not accessible to other devices during atrial fibrillation surgery.

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“…In 2006, Akpinar and coworkers reported the results of a randomized trial in which 67 patients with permanent AF undergoing minithoracotomy mitral valve surgery with or without AF ablation with unipolar endocardial RF (Cardioblate, Medtronic Corp., Minneapolis, MN, USA) [57]. The pulmonary veins were isolated as pairs, and a lesion was then placed to the mitral valve annulus.…”

Section: Concomitant Minimally Invasive Af Surgery and Mitral Valmentioning

confidence: 99%

Minimally Invasive Surgical Therapies for Atrial Fibrillation

2012

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Atrial fibrillation is the most common sustained arrhythmia and is associated with significant risks of thromboembolism, stroke, congestive heart failure, and death. There have been major advances in the management of atrial fibrillation including pharmacologic therapies, antithrombotic therapies, and ablation techniques. Surgery for atrial fibrillation, including both concomitant and stand-alone interventions, is an effective therapy to restore sinus rhythm. Minimally invasive surgical ablation is an emerging field that aims for the superior results of the traditional Cox-Maze procedure through a less invasive operation with lower morbidity, quicker recovery, and improved patient satisfaction. These novel techniques utilize endoscopic or minithoracotomy approaches with various energy sources to achieve electrical isolation of the pulmonary veins in addition to other ablation lines. We review advancements in minimally invasive techniques for atrial fibrillation surgery, including management of the left atrial appendage.

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Robotic-Enhanced Totally Endoscopic Mitral Valve Repair and Ablative Therapy

Cited by 18 publications

References 6 publications

A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay

A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay

Surgical ablation for atrial fibrillation: The efficacy of a novel bipolar pen device in the cardioplegically arrested and beating heart

Minimally Invasive Surgical Therapies for Atrial Fibrillation

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