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Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

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https://www.readbyqxmd.com/read/28129316/coronary-artery-disease-complexity-on-the-outcomes-of-a-staged-approach-of-pci-followed-by-minimally-invasive-valve-surgery
#1
Andrés M Pineda, Saqib A Gowani, Christos G Mihos, Ramesh Chandra, Orlando Santana, Joseph Lamelas, Nirat Beohar
OBJECTIVE: A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the combined coronary artery bypass graft and valve surgery for patients with concomitant coronary artery (CAD) and valvular heart disease. We sought to evaluate the impact of the complexity of CAD, as assessed by the Syntax score, on the outcomes of the staged approach. METHODS: We retrospectively evaluated 138 patients who underwent PCI and MIVS at our institution between January 2009 and June 2013...
January 27, 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28121640/veno-venous-extracorporeal-membrane-oxygenation-use-in-the-treatment-of-bleomycin-pulmonary-toxicity
#2
Aakash Shah, Chetan Pasrija, Anthony Kronfli, Brody Wehman, Bartley P Griffith, Pablo G Sanchez, Jose P Garcia, Zachary N Kon
Pulmonary toxicity is a devastating complication of bleomycin chemotherapy. This insult is likely exacerbated by the free radical injury induced by high inspired oxygen content, which is required to support these patients. Traditional treatment consists of high-dose corticosteroids. We report the case of a 45-year-old man who developed bleomycin pulmonary toxicity, which failed to respond to treatment with high-dose corticosteroids. We used protective mechanical ventilatory settings while supported on veno-venous extracorporeal membrane oxygenation using a bicaval dual-lumen, single cannula system to allow for lung recovery...
January 24, 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28129321/noninvasive-quantification-of-blood-flow-in-epicardial-coronary-arteries-coronary-artery-bypass-grafts-and-anastomoses
#3
T Bruce Ferguson, Cheng Chen, Sunghan Kim, Kenneth Jacobs, Zhiyong Peng, Zhen Zhu, Ashesh N Buch, Jeffery C Basham
OBJECTIVE: Direct flow measurement in native epicardial coronary arteries, bypass conduits, and anastomoses is severely limited by the invasiveness and inaccuracy of existing technologies. As a result, less than 25% of patients undergoing coronary artery bypass grafting (CABG) worldwide have any intraoperative evaluation performed. A simple, accurate, and noninvasive technology to directly quantify blood flow and rheology surrounding anastomotic sites is a critical unmet need in CABG...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28129320/totally-endoscopic-robotic-left-atrial-appendage-closure-demonstrates-high-success-rate
#4
Alison F Ward, Robert M Applebaum, Nana Toyoda, Ans Fakiha, Peter J Neuburger, Jennie Ngai, Robert G Nampiaparampil, David W Yaffee, Didier F Loulmet, Eugene A Grossi
OBJECTIVE: In patients with atrial fibrillation, 90% of embolic strokes originate from the left atrial appendage (LAA). Successful exclusion of the LAA is associated with a lower stroke rate in patients with atrial fibrillation. Surgical oversewing of the LAA is often incomplete when evaluated with transesophageal echocardiogram (TEE). External closure techniques of suturing and stapling have also demonstrated high failure rates with persistent flow and large stumps. We hypothesized that the precise visualization of a robotic LAA closure (RLAAC) would result in superior closure rates...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28129319/mini-bentall-an-interesting-approach-for-selected-patients
#5
Elisa Mikus, Antonio Micari, Simone Calvi, Maria Salomone, Marco Panzavolta, Marco Paris, Mauro Del Giglio
OBJECTIVE: Minimally invasive surgery through an upper hemisternotomy for aortic valve replacement has become the routine approach with excellent results. Actually, the same minimally invasive access is used for complex ascending aorta procedures only in few centers. We report our experience with minimally invasive approach for aortic valve and ascending aorta replacement using Bentall technique. METHODS: From January 2010 to November 2015, a total of 238 patients received ascending aorta and aortic valve replacement using Bentall De Bono procedure at our institution...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28129318/initial-experience-with-minimally-invasive-surgical-exclusion-of-the-left-atrial-appendage-with-an-epicardial-clip
#6
Nathan E Smith, Jeevan Joseph, John Morgan, Saqib Masroor
OBJECTIVE: Atrial fibrillation (AF) is the primary cardiac abnormality associated with ischemic stroke. Atrial fibrillation affects 2.7 million people with a stroke rate of 3.5% per year. Most of the emboli in patients with nonvalvular AF originate in the left atrial appendage (LAA). Surgical exclusion of the LAA decreases the yearly risk of stroke to 0.7% when combined with a Maze procedure. Traditional oversewing the LAA from inside the left atrium is associated with a significant number of recanalizations of LAA...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28129317/a-novel-treatment-using-an-intraventricular-stent-graft-for-postinfarction-ventricular-septal-rupture-in-a-porcine-model
#7
Yuji Nishida, Shigeyuki Tomita, Ryuta Kiuchi, Hiroshi Ohtake, Go Watanabe
OBJECTIVE: Ventricular septal rupture (VSR) is a severe complication of acute myocardial infarction, and the conventional technique for repair is associated with high operative mortality. A novel intraventricular stent graft (IVSG) device was tested as a less invasive treatment for VSR; it does not require cardiopulmonary bypass, cardiac arrest, or left ventricular incision. Its effectiveness was assessed using animal experiments. METHODS: Six pigs were placed on cardiopulmonary bypass...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28118160/we-know-what-the-cardiac-surgeon-did-during-last-hybrid-arrhythmia-procedure
#8
Narendra Kumar, Laurent Pison, Sandro Gelsomino, Ismail Aksoy, Mark La Meir, Jos Maessen
Superior vena cava (SVC) is an important source of origin of atrial fibrillation (AF) triggers other than a pulmonary vein. Because of the proximity of SVC-aorta ganglionic plexi to the SVC and the extension of myocardium in the SVC from the right atrium, SVC frequently becomes an important source of ectopic beats initiating AF. The potential complications of SVC isolation may include sinus node injury. Sinus node isolation was observed in a patient who had undergone previous surgical isolation of SVC for AF, while attempting to ablate endocardially, near the superior part of interatrial septum for an atrial tachycardia...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28106619/video-assisted-thoracic-surgery-in-patients-with-previous-sternotomy-and-cardiac-surgery
#9
Derek R Serna-Gallegos, Heather E Merry, Robert J McKenna
OBJECTIVE: Although video-assisted thoracic surgery (VATS) lobectomy has become a standard approach for early-stage 1 lung cancer, concerns exist regarding potential damage to the heart or bypass grafts when VATS is performed after cardiac surgery via median sternotomy. We could find only case reports regarding VATS lobectomy after sternotomy for cardiac surgery. Therefore, we reviewed our series of patients who underwent VATS anatomic resections after sternotomy for cardiac surgery. METHODS: Between 1996 and 2010, there were 87 patients who underwent 88 pulmonary resections after sternotomy for coronary artery bypass grafting (64), valve replacement or repair (12), coronary artery bypass graft and valve replacement (6), and transplant (5)...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28106618/right-internal-mammary-artery-use-in-140-robotic-totally-endoscopic-coronary-bypass-cases-toward-multiarterial-grafting
#10
Husam H Balkhy, Sandeep Nathan, Susan E Arnsdorf, Dorothy J Krienbring
OBJECTIVE: Benefits of adding a second arterial graft in coronary bypass are well documented. In patients requiring mulitvessel grafting robotic totally endoscopic coronary bypass (TECAB) has allowed for routine harvesting and use of the right internal mammary artery (RIMA). We retrospectively reviewed the technical considerations and target choice in 140 cases of beating heart TECAB where a RIMA graft was used. METHODS: In 2008, we introduced beating heart TECAB with anastomotic connectors into our practice, first with single IMA and then with bilateral internal mammary artery...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28099179/traditional-sternotomy-versus-minimally-invasive-aortic-valve-replacement-in-patients-stratified-by-ejection-fraction
#11
Tom C Nguyen, Vinod H Thourani, Justin Q Pham, Yelin Zhao, Matthew D Terwelp, Prakash Balan, Daniel Ocazionez, Catalin Loghin, Richard W Smalling, Anthony L Estrera, Joseph Lamelas
OBJECTIVE: Low ejection fraction (EF < 40%) portends adverse outcomes in patients undergoing valvular heart surgery. The role of traditional median sternotomy aortic valve replacement (SAVR) compared with minimally invasive aortic valve replacement (MIAVR) in this cohort remains incompletely understood. METHODS: A multi-institutional retrospective review of 1503 patients who underwent SAVR (n = 815) and MIAVR via right anterior thoracotomy (n = 688) from 2011 to 2014 was performed...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28092294/outcomes-of-a-combined-approach-of-percutaneous-coronary-revascularization-and-cardiac-valve-surgery
#12
Orlando Santana, Sandeep Singla, Christos G Mihos, Andrés M Pineda, Gregg W Stone, Paul A Kurlansky, Isaac George, Ajay J Kirtane, Craig R Smith, Nirat Beohar
A subset of patients requiring coronary revascularization and valve surgery may benefit from a combined approach of percutaneous coronary intervention (PCI) and valve surgery, as opposed to the standard median sternotomy approach of combined coronary artery bypass and valve surgery. To evaluate its potential benefits and limitations, a literature search was performed using PubMed, EMBASE, Ovid, and the Cochrane library, through March 2016 to identify all studies involving a combined approach of PCI and valve surgery in patients with coronary artery and valvular disease...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28085691/robot-assisted-mitral-valve-repair-with-posterior-leaflet-extension-for-rheumatic-disease
#13
Burak Onan, Unal Aydin, Zeynep Kahraman, Korhan Erkanli, Ihsan Bakir
Mitral valve repair has been one of the widely used applications of robotic surgery. Patients with rheumatic mitral disease usually present at an early age with thickening, retraction, or fusion of the leaflets and subvalvular apparatus. Robotic mitral repair can be feasible among this group of patients, rather than replacement. Herein, we describe a young woman who presented with rheumatic mitral valve insufficiency. A complex mitral repair with posterior leaflet extension with an autologous pericardial patch was successfully conducted using robot assistance...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28085690/a-novel-robotic-bilateral-internal-mammary-artery-harvest-using-double-docking-technique-for-coronary-artery-bypass-grafting
#14
Tatsuya Tarui, Norihiko Ishikawa, Go Watanabe
da Vinci Surgical System (da Vinci) enabled port access for internal mammary arteries (IMA) harvesting. However, bilateral IMA (BIMA) harvesting is difficult when performed on single side. We developed a novel technique of double docking the da Vinci by transpositioning from the left side to the right and examined the feasibility. Twelve patients underwent BIMA harvesting using the double-docking technique. First, the da Vinci was set on the patient's left side for the right IMA harvesting. Afterward, the da Vinci was undocked and transpositioned from the patient's left side to the right side...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28085689/consideration-of-native-coronary-disease-progression-in-the-decision-to-perform-hybrid-coronary-revascularization
#15
Maria L Rodriguez, David Glineur, Marc Ruel
No abstract text is available yet for this article.
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28085688/schwannoma-of-the-recurrent-laryngeal-nerve-a-rare-entity
#16
Linda M de Heer, Ferdinand Teding van Berkhout, Loudy P Priesterbach-Ackley, Marc P Buijsrogge
Neurogenic tumors are the most common posterior mediastinal tumors in adults. Schwannomas originating from the recurrent laryngeal nerve are rare. The present study describes a 46-year-old man with a tumor in the left superior mediastinum. Because of the narrow relationship with the aorta and the left pulmonary artery, the tumor was excised by left-sided minithoracotomy. The tumor, a schwannoma, originated from and encased the left recurrent laryngeal nerve. Six months after surgery, the patient was free of recurrence without symptoms other than hoarseness...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27918317/minimally-invasive-robotically-assisted-repair-of-partial-anomalous-venous-connection
#17
Luigi Pirelli, Chad A Kliger, Nirav C Patel, Marcella Bono, Carlos E Ruiz, Vladimir Jelnin, Gregory P Fontana
We describe a novel robotically assisted minimally invasive surgical technique for repair of partial anomalous pulmonary vein connection (PAPVC). Partial anomalous pulmonary vein connection is a rare congenital anomaly that consists in drainage of one or more pulmonary veins into the systemic venous system. Traditionally, large thoracotomy incision and sometimes establishment of cardiopulmonary bypass are needed to redirect the abnormal pulmonary vein to the left-sided reservoir. We describe a robotically assisted, minimally invasive, off-pump technique for the treatment of the left PAPVC in a 57-year-old patient with signs of progressive right ventricular dilatation...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27930604/an-automated-expanded-polytetrafluoroethylene-suturing-and-coaxial-fastener-system-for-mitral-chordae-replacement-strength-feasibility-and-healing
#18
Candice Y Lee, Joshua K Wong, Jude S Sauer, Heather R Gorea, Angelo J Martellaro, Andrew R Sifain, Peter A Knight
OBJECTIVE: Mitral valve (MV) chordae replacements can be technically challenging. Technology that remotely delivers and accurately secures artificial chordae may reduce the learning curve and improve the reliability of MV repairs. METHODS: The technology involved two devices: a remote suturing device for delivery of expanded polytetrafluoroethylene (ePTFE) suture to the papillary muscle and a Coaxial titanium suture fastener (TF) device with integrated saline infusion for real-time determination of chordae length during fixation...
November 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27930603/strategies-to-improve-the-efficacy-of-epicardial-linear-ablation-on-the-beating-heart
#19
Yoshiyuki Watanabe, Matthew R Schill, Toshinobu Kazui, Spencer J Melby, Richard B Schuessler, Ralph J Damiano
OBJECTIVE: Creating transmural linear lesions on the beating heart is an important component of minimally invasive surgical ablation for atrial fibrillation. Animal studies have shown poor efficacy for surface bipolar radiofrequency ablation (RFA). Clinicians have developed strategies including multiple device applications and vena caval occlusion (VCO) to improve ablation efficacy. These techniques were evaluated in an acute porcine model. METHODS: In the first experiment, an RFA device was used to perform two 40-second epicardial ablations on the right atrium of six pigs...
November 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27930602/an-early-canadian-experience-with-the-correx-automated-coring-and-apical-connector-device-for-aortic-valve-bypass
#20
Hussein A Al-Amodi, Christopher L Tarola, Hamad F Alhabib, Corey Adams, Linrui Ray Guo, Bob B Kiaii
OBJECTIVE: Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or pre-existing comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. METHODS: At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system...
November 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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