Innovations : technology and techniques in cardiothoracic and vascular surgery
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Innovations (Phila) · Jul 2013
Case ReportsCombined totally endoscopic robotic coronary bypass and mitral valve repair via right-sided ports.
We present a case of combined coronary artery bypass grafting and mitral valve (MV) repair using a robotic totally endoscopic right-sided approach. A 61-year-old man presented with fatigue due to significant mitral regurgitation and was found to have a tight stenosis in the mid left anterior descending artery. ⋯ The patient was discharged from the hospital 3 days postoperatively and returned to normal activity within 3 weeks after surgery. This case study shows the feasibility of using an endoscopic robotic approach in selected patients undergoing combined MV coronary artery bypass grafting surgery.
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Innovations (Phila) · Jul 2013
Performance of a novel bipolar/monopolar radiofrequency ablation device on the beating heart in an acute porcine model.
Although the advent of ablation technology has simplified and shortened surgery for atrial fibrillation, only bipolar clamps have reliably been able to create transmural lesions on the beating heart. Currently, there are no devices capable of reproducibly creating the long linear lesions in the right and left atria needed to perform a Cox-Maze procedure. This study evaluated the performance of a novel suction-assisted radiofrequency device that uses both bipolar and monopolar energy to create lesions from an epicardial approach on the beating heart. ⋯ This novel device was able to consistently create transmural epicardial lesions on the beating heart, regardless of anatomic location, cardiac output, or tissue thickness. The performance of this device was improved over most devices previously tested but still falls short of ideal clinical performance. Transmurality was lower at the end of the lesions, highlighting the importance of overlapping lines of ablation in the clinical setting.
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Innovations (Phila) · May 2013
Are there gender differences in outcomes after the Cox-Maze procedure for atrial fibrillation?
Atrial fibrillation (AF) management suggests that women do not tolerate medication rhythm control strategies as well as men do; however, AF percutaneous catheter ablation has been found to be favorable. The study purpose was to compare the sex-based outcomes for patients who undergo the Cox-Maze procedure for AF. ⋯ Outcomes after the Cox-Maze procedure are similar across sex. Atrial fibrillation surgical ablation should be considered a treatment option for women-it is safe and effective, improves general health-related quality of life, and reduces AF symptom burden.
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Innovations (Phila) · May 2013
Navigating the pathway to robotic competency in general thoracic surgery.
Although robotic technology has addressed many of the limitations of traditional videoscopic surgery, robotic surgery has not gained widespread acceptance in the general thoracic community. We report our initial robotic surgery experience and propose a structured, competency-based pathway for the development of robotic skills. ⋯ Robot-assisted thoracic surgery can be safely learned when skill acquisition is guided by a structured, competency-based pathway.
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Innovations (Phila) · Jan 2013
Outcome of the impella device for acute mechanical circulatory support.
The contribution of cardiogenic shock to in-hospital mortality has not decreased significantly despite prompt revascularization, advances in medical therapy, and mechanical circulatory support. For patients in cardiogenic shock, mechanical circulatory support has been provided by a variety of devices. We report the outcome of the Impella device for acute mechanical circulatory support in cardiogenic shock in a setting of a large-volume single institution. The primary end points include survival to 30 days and recovery of native heart function and survival to 90 days and 1 year. The secondary end points include device complications. ⋯ The Impella devices yielded a very favorable outcome in patients with cardiogenic shock.