Totally endocsopic atrial septal defect closure with a robotic system: Experience with seven cases

Background: The development of minimally invasive cardiac surgery has shown good clinical results with shorter recovery time and better cosmetic results. The introduction of the robotic systems can further reduce the surgical trauma and improve the surgical dexterity. We report seven cases of complete closed chest atrial septal defect closure using the "da Vinci"™ Surgical System (Intuitive Surgical, Mountain View, CA). Methods: Following peripheral cannulation for cardiopulmonary bypass (CPB), aortic occlusion and cardioplegia delivery, five patients with atrial septal defect (ASD) and two patients with patent forame ovale (PFO) with atrial septal aneurysm (ASA) were successfully treated using the robotic system. Two robotic arms and an endoscopic camera were inserted through ports in the right hemithorax and an accessory port was placed for blood suction and ancillary instruments insertion. The defect closure was carried out with interrupted stitches in one patient and with a continuous suture in the others. Results: Mean cardiopulmonary bypass and cross clamp time were 101.8 ± 39.6 and 63.4 ± 21.9 minutes respectively. Extubation was carried out within the seventh postoperative hour. All patients returned to normal lifestyle in one week. Conclusion: Complete closed chest ASD closure can be carried out using robotic technique with rapid postoperative recovery and excellent cosmetic result

Standard versus hemodynamic plus 19-mm St Jude Medical aortic valves

AbstractObjective: We reviewed our experience with aortic valve replacement using 19-mm St Jude Medical prostheses (St Jude Medical, Inc, St Paul, Minn) in 119 patients, among which 68 (group A) had a Standard model and 51 (group B) had a Hemodynamic Plus model. Methods: Comparison between the 2 models included analysis of early and late mortality and all valve-related complications. Postoperative echocardiography was performed to evaluate the hemodynamic performance of both prosthetic models. Laboratory tests were performed to evaluate the amount of red blood cell damage caused by the transprosthetic turbulent flow. Results: Average body surface area was 1.66 ± 0.14 m2 in group A and 1.65 ± 0.16 m2 in group B (P =.72). There was no statistically significant difference between the 2 groups in terms of preoperative variables (sex, cardiac rhythm, body surface area, preoperative gradients, and New York Heart Association class). Five-year follow-up was 100% complete. Although group A patients had significantly higher postoperative peak and mean gradients (P =.0001) and a lower effective orifice area (P =.0001), no statistical differences were found in terms of late (5-year) survival (P =.6) and postoperative complications (P =.09). Moreover, postoperative left ventricular mass was found to be similar in the 2 groups (P =.18). Hematologic evaluation did not show any significant difference between the 2 groups as to incidence of hemolysis. Conclusions: Aortic valve replacement with 19-mm aortic prostheses in patients with a body surface area of less than 1.7 m2 allows good results. Although Hemodynamic Plus models have better hemodynamic results, no significant difference was found in terms of clinical results and clinical hemolysis. (J Thorac Cardiovasc Surg 2001;121:723-8

Acute effects of beating heart coronary surgery on left ventricular performance

Background. The increasing use of off-pump bypass grafting (OPCABG), requires an evaluation of its effects on left ventricular (LV) performance. Methods. In 8 patients with multivessel coronary disease who were undergoing to off-pump coronary artery bypass grafting, LV performance was analyzed from the pressure-volume (P-V) plane by the conductance catheter technique. Measurements were performed at base line, after the exposure of the vessels, after the application of the stabilization system, and at the end of the procedure. Results. No significant changes in heart rate, LV end-systolic volume, LV end-diastolic pressure, mean pulmonary artery, and mean systemic blood pressure were observed in the various stages of the procedure. Cardiac index decreased during left anterior descending coronary artery grafting after application of the stabilizer with a concomitant decrease in LV end-diastolic volume, together with decreases in LV peak negative -dP/dt and increases in τ, indicating an impairment of LV relaxation but without a change in preload recruitable stroke work, indicating preserved LV contractile state. Exposure of posterior and lateral vessels induced a decrease in cardiac index and preload recruitable stroke work without a decrease in LV preload, indicating a decrease in LV contractile state together with a decrease in peak -dP/dt and increase in τ, indicating an impairment in LV relaxation. Conclusions. Off-pump coronary artery bypass grafting can be performed without decreasing LV performance. Major cardiac displacement like that used for posterior and lateral exposure induces acutely significant decrease in LV contractile state. © 2002 by The Society of Thoracic Surgeons

Echocardiographic appearance of normally functioning Sorin Bicarbon valve prostheses

A clinical and echocardiographic study was carried out to evaluate the performance of the Sorin Bicarbon bileaflet valve. From December 1990 to December 1994, 100 patients underwent isolated mitral (64) or aortic (36) valve replacement. There were 39 males and 61 females, with ages ranging from 21 to 73 years (mean 62 ± 9.6 years). Forty-three patients underwent a transthoracic continuous pulsed color Doppler echocardiogram at 3 and 6 months postoperatively. For mitral prostheses, the parameters calculated were valve area, pressure half-time and mean gradient; for aortic prostheses, peak and mean gradients were measured. Results were compared by analysis of variance to those obtained in patients matched for sex, body surface area, cardiac rhythm, site, and size of the prosthesis who had St. Jude Medical or CarboMedics valves implanted. No statistically significant differences were found among the 3 prosthetic heart valves. The operative mortality was 7%; 3 cases of fatal cerebral hemorrhage occurred in the early postoperative period. There was 1 late mortality, 1 case of transient cerebral ischemia, and 1 of gastric bleeding, all occurring in patients with mitral prostheses. Midterm follow-up was satisfactory, although a larger series is required to confirm these results