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Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

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https://read.qxmd.com/read/31099278/minimally-invasive-lobectomy-modality-and-other-predictors-of-conversion-to-thoracotomy
#1
Brandon S Hendriksen, Christopher S Hollenbeak, Matthew D Taylor, Michael F Reed
OBJECTIVE: Minimally invasive approaches to lobectomy are increasing. Rates of conversion to thoracotomy are well reported but risk factors are poorly understood. This study aimed to determine the impact of surgical modality (video-assisted thoracoscopic surgery [VATS] and robotic) on conversion as well as to identify other risk factors for conversion. METHODS: The National Cancer Database (NCDB) was used to identify patients who underwent minimally invasive lobectomy between 2010 and 2015...
May 17, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31088318/longitudinal-outcomes-of-women-undergoing-transcatheter-aortic-valve-replacement
#2
Arman Kilic, Valentino Bianco, Thomas G Gleason, Joon S Lee, John Schindler, Forozan Navid, Dustin Kliner, Joao L Cavalcante, Suresh R Mulukutla, Ibrahim Sultan
OBJECTIVE: Recent data have suggested that women have a survival benefit at 1-year follow-up. However, long-term gender-based TAVR outcomes are lacking. METHODS: All patients undergoing isolated TAVR from 2011 to 2017 were included. Patients were stratified by gender. The primary outcomes of the study were 3-year mortality and 3-year hospital readmissions. Multivariable logistic regression analysis was used to evaluate the risk-adjusted impact of gender on TAVR outcomes...
May 15, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31084446/right-anterior-minithoracotomy-for-aortic-valve-replacement-a-widely-applicable-simple-and-stepwise-approach
#3
Igo B Ribeiro, Marc Ruel
OBJECTIVE: A stepwise approach for right anterior minithoracotomy aortic valve replacement (RAT-AVR), without sutureless valves, special instruments, or preoperative imaging, was developed. We report our experience with this widely applicable, simplified approach. METHODS: Patients with a history of previous chest surgery, documented PVD, severe COPD, LVOT size <2.0 cm, and root size <2.8 cm were excluded. Chest CT was not mandatory. The stepwise surgical approach consists of 1) tolerability of single-lung ventilation; 2) 5-cm long incision on third right anterior ICS; 3) small pericardial opening to localize the aortic valve annular plane by digital palpation; 4) shingling of the correct rib to create a box field; 5) optimizing exposure with stay sutures; 6) femoral or central cannulation with right superior pulmonary vein venting and usual antegrade cardioplegia; 7) performing a standard AVR without adjunct instruments; and 8) reconstructing 1 costochondral cartilage...
May 14, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31084444/predictors-of-aortic-valve-repair-failure
#4
Bobby Yanagawa, Amine Mazine, Ismail El-Hamamsy
Aortic valve repair is the preferred approach for the treatment of severe aortic insufficiency (AI), as it allows patients to keep their native aortic valve, thus substantially reducing the risk of prosthesis-related complications. Several studies have documented excellent long-term outcomes of aortic valve repair. The major complication of this operation is AI recurrence, with ensuingneed for reoperation. The surgical experience accumulated over the last two decades has allowed for better understanding of the mechanisms of recurrent AI after aortic valve repair...
May 14, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31081708/evolution-of-minimally-invasive-surgical-aortic-valve-replacement-at-a-veterans-affairs-medical-center
#5
Norah E Liang, Andrew D Wisneski, Curtis J Wozniak, Liang Ge, Elaine E Tseng
OBJECTIVE: The majority of minimally invasive surgical aortic valve replacements (MIAVRs) are performed at high-volume cardiac surgery centers. However, outcomes at lower volume federal facilities are not yet reported in the literature and not captured in the national Society of Thoracic Surgeons (STS) database. Our study objective was to describe the evolution of MIAVR at a Veterans Affairs Medical Center (VAMC). METHODS: A single-center retrospective cohort study was performed of 114 patients who underwent MIAVR for isolated aortic valvular disease between January 2011 and August 2018...
May 13, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31074313/impact-of-valve-size-on-prosthesis-patient-mismatch-and-aortic-valve-gradient-after-transcatheter-versus-surgical-aortic-valve-replacement
#6
Seyed Hossein Aalaei-Andabili, Teng C Lee, Nida Waheed, Anthony A Bavry, John W Petersen, Siddharth Wayangankar, George J Arnaoutakis, R David Anderson, Thomas M Beaver
OBJECTIVE: Limited data is available about the effect of implanted valve size on prosthesis-patient mismatch (PPM) incidence and aortic gradient (AG) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We compared PPM incidence and postprocedural AG between TAVR and SAVR patients considering the impact of implanted valve size. METHODS: From March 20, 2012, to September 30, 2015, 563 consecutive patients underwent TAVR ( n = 419) or isolated SAVR ( n = 144)...
May 10, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31050325/racial-disparities-and-outcomes-after-left-ventricular-assist-device-implantation-as-bridge-to-transplantation-or-destination-therapy
#7
Alexis K Okoh, Olivia Chan, Molly Schultheis, Setri Fugar, Nathan Kang, Sari Kaplon, Ravindra Karanam, Mark Russo, Mark Zucker, Margarita Camacho
OBJECTIVE: We sought to investigate outcomes after left ventricular assist device (LVAD) implantation in advanced heart failure patients stratified by race. METHODS: Patients who had LVADs inserted at a single center as a bridge to transplant (BTT) or destination therapy (DT) were divided into 3 groups based on race: Caucasian, African American (AA), and Hispanic. Postoperative outcomes including complications, discharge disposition, and survival at defined time points were compared...
May 3, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31050324/the-10-commandments-for-aortic-valve-repair
#8
Hans-Joachim Schäfers
No abstract text is available yet for this article.
May 3, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31050323/robotic-septal-myectomy-without-anterior-leaflet-incision-duri%C3%AC-ng-mitral-valve-repai%C3%AC-r
#9
Burak Onan, Ersin Kadirogullari, Zeynep Kahraman, Onur Sen
Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During "minimally invasive endoscopic" and "robotic" mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus...
May 3, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31050322/minimally-invasive-pulmonary-artery-aneurysm-repair-through-a-left-anterior-minithoracotomy-an-alternative-approach
#10
Sana Rahman, Gary Cook, Jing Zheng, Atiq Rehman
The purpose in this case was to repair a less invasive approach than a standard sternotomy. Workup of asymptomatic patient with computerized tomography scan of chest revealed pulmonary artery aneurysm and transesophageal echocardiography demonstrated flow stagnation in aneurysm. An alternative minimally invasive approach was performed to repair the pulmonary artery aneurysm with plication through a left anterior minithoracotomy using normothermic cardiopulmonary bypass with percutaneous peripheral cannulation, instead of median sternotomy...
May 3, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31050321/hybrid-arch-frozen-elephant-trunk-repair-of-complex-arch-aneurysm-with-severe-arterial-tortuosity
#11
Muhanad S Algadheeb, Fahd Makhdom, Audra Duncan, Michael W A Chu
Patients with complex aortic arch aneurysms and severe arterial tortuosity represent a unique challenge because of extreme angulations, mixed aneurysm and stenotic disease, and fragile tissues. Novel hybrid arch frozen elephant trunk techniques can expand surgical repair options to include single-stage, complete aortic reconstruction via sternotomy alone, without the need for simultaneous thoracotomy or clamshell incisions. We describe successful hybrid aortic arch reconstruction with Thoraflex Hybrid graft in a patient with complex arch aneurysm and severe arterial tortuosity...
May 3, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/31050320/successful-transition-to-robotic-assisted-lobectomy-with-previous-proficiency-in-thoracoscopic-lobectomy
#12
Robert E Merritt, Peter J Kneuertz, Desmond M D'Souza
OBJECTIVE: The learning curve and the advantages of transitioning to robotic-assisted lobectomy by a surgeon who is proficient in thoracoscopic lobectomy is currently unknown. The cost of robotic lobectomy has been reported to be higher than thoracoscopic lobectomy and there is no significant decrease in hospital length of stay. METHODS: This is a retrospective review of 228 patients diagnosed with lung carcinoma who underwent minimally invasive lobectomy from March 2014 to May 2018...
May 3, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/30885092/graft-patency-after-robotically-assisted-coronary-artery-bypass-surgery
#13
Hiroto Kitahara, Sarah Nisivaco, Husam H Balkhy
OBJECTIVE: With advances in robotic instrumentation and technology, both robotically assisted minimally invasive direct coronary artery bypass (RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been widely used over the past 20 years. Graft patency is the most important outcome in coronary bypass surgery and is associated with long-term prognosis. In this article we reviewed all experts' studies in the field of robotic assisted coronary artery bypass and investigated graft patency in patients who underwent RMIDCAB or TECAB...
March 18, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/30885091/clinical-and-functional-outcomes-associated-with-age-after-transapical-transcatheter-aortic-valve-replacement
#14
Alexis Kofi Okoh, Nathan Kang, Nicky Haik, Setri Fugar, Chen Chunguang, Haik Bruce, Marc Cohen, Mark J Russo
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) via a transapical (TA) approach has been associated with high morbidity. The aim of this study is to investigate the association of age and clinical and functional outcomes after TA-TAVR. METHODS: Patients who had TA-TAVR at a single center were divided into 3 age groups: <75 years (Group I), 75 to 85 years (Group II), and >85 years (Group III). Pre- and postoperative clinical, functional status, and procedure-related outcomes were compared among patient groups...
March 18, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/30885090/percutaneous-coronary-intervention-following-placement-of-sutureless-aortic-bioprostheses
#15
Kiran Kaur, Miryea Cisneros, Sandeep Nathan, John E A Blair, Husam H Balkhy
Coronary artery disease is often present with aortic stenosis. Although transcatheter aortic valve replacement and minimally invasive surgery provide alternative sternal-sparing options for isolated aortic valve replacement, non-sternotomy treatment of combined coronary artery disease and aortic stenosis has not been well-defined. We report 3 patients who presented with severe aortic stenosis and obstructive coronary artery disease in whom minimally invasive aortic valve replacement using sutureless valve was performed, followed by transradial percutaneous coronary intervention of obstructive coronary lesion...
March 18, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/30885089/variation-in-platelet-transfusion-practices-in-cardiac-surgery
#16
Xun Zhou, Charles D Fraser, Alejandro Suarez-Pierre, Todd C Crawford, Diane Alejo, John V Conte, Jennifer S Lawton, Clifford E Fonner, Bradley S Taylor, Glenn J R Whitman, Rawn Salenger
OBJECTIVE: Although the morbidity associated with red blood cell transfusion in cardiac surgery has been well described, the impacts of platelet transfusion are less clearly understood. Given the conflicting results of prior studies, we sought to investigate the impact of platelet transfusion on outcomes after cardiac surgery across institutions in Maryland. METHODS: Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative, we retrospectively analyzed data from 10,478 patients undergoing isolated coronary artery bypass across 10 centers...
March 18, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/30885087/coronary-pulmonary-artery-fistula-ligation-and-mitral-valve-repair-through-a-mini-thoracotomy-approach
#17
Hiroto Kitahara, Chiharu Tanaka, Sentaro Nakanishi, Naohiro Wakabayashi, Natsuya Ishikawa, Hiroyuki Kamiya
A 39-year-old man with severe mitral regurgitation was referred to our institution for surgical evaluation. During preoperative workup, a coronary-pulmonary artery fistula was incidentally found by computed tomography. After multidisciplinary cardiac team discussion, the decision was made to proceed with coronary-pulmonary artery fistula ligation and mitral valve repair through a mini-thoracotomy approach. Cardiopulmonary bypass was initiated with femoral vessels. A mini-thoracotomy was made in the fourth intercostal space...
March 18, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/30885086/left-internal-thoracic-artery-graft-assessment-by-firefly-fluorescence-imaging-for-robot-assisted-minimally-invasive-direct-coronary-artery-bypass
#18
Yoshitsugu Nakamura, Miho Kuroda, Yujiro Ito, Takahiko Masuda, Shuhei Nishijima, Takahisa Hirano, Shinichi Hisasue
OBJECTIVE: The da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) cannot give tactile feedback to surgeons. This shortcoming may increase the risk of left internal thoracic artery (LITA) injury during its harvest. We utilized Firefly Fluorescence Imaging (Firefly) to assess LITA quality in robot-assisted minimally invasive direct coronary artery bypass (R-MIDCAB). METHODS: We retrospectively reviewed clinical records and intraoperative videos of 30 consecutive patients who underwent R-MIDCAB with LITA-left anterior descending (LAD) coronary bypass...
March 18, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/30871402/a-case-of-coronary-artery-fistula-ligation-in-minimally-invasive-mitral-valve-plasty-via-right-anterolateral-minithoracotomy
#19
Nobuo Kondo, Toshinori Totsugawa, Hidenori Yoshitaka, Taichi Sakaguchi
We report a case of coronary artery fistula treated by ligation with concomitant minimally invasive mitral valve plasty via right anterolateral minithoracotomy. The coronary artery fistula was isolated well under heart beating, and clip-ligation was easily and safely performed. The present method is an effective and safe option for use with minimally invasive cardiac surgery.
March 14, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://read.qxmd.com/read/30871401/double-valve-in-valve-transcatheter-valve-replacements-for-failed-surgical-bioprosthetic-aortic-and-tricuspid-valves
#20
Kyongjune B Lee, Gregory D Trachiotis, Jonathan S Reiner, Christian D Nagy
Transcatheter technology has revolutionized the treatment of valvular disease in the field of cardiology and cardiac surgery. We present an interesting case of a patient with prior double valve replacements, which had degenerated after a decade, with symptoms of decompensated heart failure. The patient was successfully treated with double valve-in-valve transcatheter aortic and tricuspid valve replacement.
March 14, 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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