Three-port (one incision plus two-port) endoscopic mitral valve surgery without robotic assistance†

Ito, Toshiaki; Maekawa, Atsuo; Hoshino, Satoshi; Hayashi, Y.; Sawaki, Shunji; Yanagisawa, Junji; Tokoro, Masayoshi

doi:10.1093/ejcts/ezw430

Cited by 22 publications

(9 citation statements)

References 10 publications

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“…This cohort study pertains to clinical outcomes of robotic MVR with bioprosthetic valves. Although MVR can be performed with satisfactory outcomes using a minimally invasive endoscopic technique [ 9 ], robot arms are comparably strong for extensive debridement of a severely calcified annulus. In addition, bioprosthetic valves have a higher profile and a wide, saddle-shaped cuff that are considered technical challenges when implanting them through a small surgical wound.…”

Section: Discussionmentioning

confidence: 99%

Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

Kuo

Chang

Hsing

et al. 2018

European Journal of Cardio-Thoracic Surgery

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OBJECTIVESRobotic mitral valve replacement (MVR) emerged in the late 1990s as an alternative approach to conventional sternotomy. With the increased use of bioprosthetic valves worldwide and strong patient desire for minimally invasive procedures, the safety and feasibility of robotic MVRs with bioprosthetic valves require investigation.METHODSBetween January 2013 and May 2017, 52 consecutive patients underwent robotic MVRs using the da Vinci Si surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Their mean age was 55.1 ± 13.8 years, and mean EuroSCORE II was 2.25% ± 1.25%. Among the enrolled patients, 32 (61.5%) patients presented with preoperative atrial fibrillation, 6 (11.5%) patients had experienced embolic stroke and 5 (9.6%) patients had undergone previous cardiac surgery. The operations were performed using cardiopulmonary bypass (CPB) under an arrested heart status.RESULTSFive porcine valves and 47 bovine valves were implanted. A total of 38 (73.1%) patients received concomitant cardiac procedures, including 26 Cox-maze IV procedures, 12 tricuspid valve repairs and 5 atrial septal defect repairs. The mean aortic cross-clamp and CPB times were 141.3 ± 34.3 min and 217.1 ± 42.0 min, respectively. There was no operative mortality. During the mean follow-up of 29 ± 15 months, no prosthesis degeneration was noted. The average left atrial dimension exhibited a significant decrease from 51.4 ± 11.5 mm to 42.6 ± 10.1 mm.CONCLUSIONSRobotic MVR with bioprosthetic valves is safe, feasible and reproducible. Mid-term results are encouraging. Both aortic cross-clamp and CPB times can be improved with experience.

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Section: Discussionmentioning

confidence: 99%

Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

Kuo

Chang

Hsing

et al. 2018

European Journal of Cardio-Thoracic Surgery

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“…Robotic mitral valve replacement (MVR) has emerged as an alternative treatment method to conventional sternotomy. There are studies indicating that minimally invasive techniques can provide significant benefits in terms of cosmetic appearance, decreased postoperative pain, lower blood transfusion rate, and faster return to daily activities compared with the traditional sternotomy approach 1‐3 . Robotic mitral valve repair has been one of the widely used applications of robotic surgery, and there are many studies on this subject 4 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of postoperative outcomes between robotic mitral valve replacement and conventional mitral valve replacement

et al. 2021

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Background Robotic mitral valve surgery continues to become widespread all over the world in direct proportion to the developing technology. In this study, we aimed to compare the postoperative results of robotic mitral valve replacement and conventional mitral valve replacement. Methods A total of consecutive 130 patients who underwent robotic mitral valve replacement and conventional mitral valve replacement with full sternotomy between 2014 and 2020 were included in our study. All patients were divided into two groups: Group I, with 64 patients who underwent robotic mitral valve replacement and Group II, with 66 patients with conventional full sternotomy. General demographic data (age, gender, body weights, etc.), comorbidities (hypertension, diabetes mellitus, chronic obstructive pulmonary disease, peripheral artery disease, hyperlipidemia, etc.), intraoperative variables (cardiopulmonary bypass times, and cross‐clamp times), postoperative ventilation times, drainage amounts, transfusion amount, inotropic need, revision, arrhythmia, intensive care and hospital stay times, and mortality were analyzed retrospectively. Results There was no significant difference between demographic data, such as age, gender, body kit index, and preoperative comorbid factors of both patient groups (p > .05). Cardiopulmonary bypass time (204.12 ± 45.8 min) in Group I was significantly higher than Group II (98.23 ± 17.8 min) (p < .001). Cross‐clamp time in Group I (143 ± 27.4 min) was significantly higher than Group II (69 ± 15.2 min) (p < .001). Drainage amount in Group I (290 ± 129 cc) was significantly lower than Group II (561 ± 136 cc) (p < .001). The erythrocyte suspension transfusion requirement was 0.4 ± 0.3 units in Group I; it was 0.9 ± 1.2 units in Group II, and this requirement was found to be significantly lower in Group I (p = .014). While the mean mechanical ventilation time was 5.3 ± 3.9 h in Group I, it was 9.6 ± 4.2 h in Group II. It was significantly lower in Group I (p = .001). Accordingly, intensive care stay (p = .006) and hospital stay (p = .003) were significantly lower in Group I. In the early postoperative period, three patients in Group I and four patients in Group II were revised due to bleeding. In the postoperative hospitalization period, neurological complications were observed in one patient in Group I and two patients in Group II. Two patients in Group I returned to the sternotomy due to surgical difficulties. Two patients died in both groups postoperatively, and there was no significant difference in mortality (p = .97). Conclusion According to conventional methods, robotic mitral valve replacement is an effective and reliable method since total perfusion and cross‐clamp times are longer, drainage amount and blood transfusion need are less, and ventilation time, intensive care, and hospital stay time are shorter.

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“…In the last years, treatment of mitral valve disease has evolved using right three-port video-assisted thoracic surgery [13] and robotics [14]. For high-risk patients, multiples techniques for transcatheter repair or replacement have emerged [15].…”

Section: Commentsmentioning

confidence: 99%

A Novel Approach in Cardiac Surgery: Neifer’s Approach

Neifer¹

2017

Glob Surg

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While cardiac surgery has well evolved in the recent decades, endoscopic access to the heart is yet involving pleura opening and transcatheter procedures are still implying X-rays use. Here I introduce a novel minimally-invasive approach based on a sternal trepanation with extrapleural intercostal port(s). This allows a totally endoscopic access to the cardiac cavity without pleura opening. Besides, using this approach with live computer simulation, transcatheter procedures will be exclusively monitored by transesophageal echocardiography without X-rays need. Thus, current indications and practices in both cardiac surgery and interventional cardiology may be affected. Until effectiveness confirmation by experiments which are still in progress, a theoretical description of this innovative technique and its potential applications is detailed in this paper.

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Three-port (one incision plus two-port) endoscopic mitral valve surgery without robotic assistance†

Abstract: Three-port endoscopic MIMVS appears reproducible and safe.

Cited by 22 publications

References 10 publications

Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

Comparison of postoperative outcomes between robotic mitral valve replacement and conventional mitral valve replacement

A Novel Approach in Cardiac Surgery: Neifer’s Approach

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