Simulation-based assessment of robotic cardiac surgery skills: An international multicenter, cross-specialty trial

Objective: This study aimed to investigate the validity of simulation-based assessment of robotic-assisted cardiac surgery skills using a wet lab model, focusing on the use of a time-based score (TBS) and modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Methods: We tested 3 wet lab tasks (atrial closure, mitral annular stitches, and internal thoracic artery [ITA] dissection) with both experienced robotic cardiac surgeons and novices from multiple European centers. The tasks were assessed using 2 tools: TBS and mGEARS score. Reliability, internal consistency, and the ability to discriminate between different levels of competence were evaluated. Results: The results demonstrated a high internal consistency for all 3 tasks using mGEARS assessment tool. The mGEARS score and TBS could reliably discriminate between different levels of competence for the atrial closure and mitral stitches tasks but not for the ITA harvesting task. A generalizability study also revealed that it was feasible to assess competency of the atrial closure and mitral stitches tasks using mGEARS but not the ITA dissection task. Pass/fail scores were established for each task using both TBS and mGEARS assessment tools. Conclusions: The study provides sufficient evidence for using TBS and mGEARS scores in evaluating robotic-assisted cardiac surgery skills in wet lab settings for intracardiac tasks. Combining both assessment tools enhances the evaluation of proficiency in robotic cardiac surgery, paving the way for standardized, evidence-based preclinical training and credentialing. Clinical trial registry number: NCT05043064.</p

Systematic Review and Meta-Analysis of Mid-Term Survival, Reoperation, and Recurrent Mitral Regurgitation for Robotic-Assisted Mitral Valve Repair

Background: Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term data for RMVr. Methods: Electronic searches of five databases were performed to identify all relevant studies reporting minimum five-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and from moderate or worse mitral regurgitation (MR) at five years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Results: Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-year were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at eight-years post RMVr was 95.0%. Freedom from moderate or worse MR at seven years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. Conclusions: RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and from moderate or worse MR recurrence

Home transfer after cardiac surgery [Le retour à domicile après une chirurgie cardiaque]

Le retour à domicile est un moment très important après une chirurgie cardiaque et correspond au retour à la vie normale et aux activités quotidiennes pour le patient. Une fois la phase péri-opératoire passée, après une période de convalescence, le patient va se retrouver très brutalement "démédicalisé". Le rôle de l'information fournie au patient durant son séjour et la coopération entre le médecin traitant, le cardiologue et le chirurgien est alors fondamentale. Tout doit être fait pour diminuer au maximum le taux des complications et accélérer le retour à la vie normale et aux activités quotidiennes. Pour une prise en charge optimale, il faut tenir compte de plusieurs facteurs tels que l’état préopératoire, le type d’intervention, les complications péri et post-opératoires, la situation sociale, l’état psychologique du patient. Chaque patient répond de manière différente à la chirurgie et la reprise après une opération du cœur est spécifique par rapport à la procédure chirurgicale. Malgré ces différences, cependant, certaines généralisations peuvent être faites

The state of robotic cardiac surgery in Europe

BACKGROUND: In the past two decades, the introduction of robotic technology has facilitated minimally invasive cardiac surgery, allowing surgeons to operate endoscopically rather than through a median sternotomy. This approach has facilitated procedures for several structural heart conditions, including mitral valve repair, atrial septal defect closure and multivessel minimally invasive coronary artery bypass grafting. In this rapidly evolving field, we review the status of robotic cardiac surgery in Europe with a focus on mitral valve surgery and coronary revascularization. METHODS: Structured searches of MEDLINE, Embase, and Cochrane databases were performed from their dates of inception to June 2016. All original studies, except case-reports, were included in this qualitative review. Studies performed in Europe were presented quantitatively. Data provided from Intuitive Surgical Inc. are also presented. RESULTS: Fourteen papers on coronary surgery were included in the analysis and reported a mortality rate ranging between 0-1%, revision for bleeding between 2-7%, conversion to a larger incision between 2-15%, and patency rate between 92-98%. The number of procedures ranged between 23 and 170 per year. There were only a small number of published reports for robotic mitral valve surgery from European centers. CONCLUSIONS: Coronary robotic surgery in Europe has been performed safely and effectively with very few perioperative complications in the last 15 years. On the other hand, mitral surgery has been developed later with increasing applications of this technology only in the last 5-6 years

Device for clean excision of a heart valve

A device (100) is presented for excision of a heart valve comprising a first (120) and second (140) clamping element in mutual sliding relation, each having an annular clamping surface (122, 142) which annular clamping surfaces (122, 142) mutually co-operate to form an annular clamping region (166) configured for clamping a heart valve annularly, and a slidable cutting element (160) slidable and rotatable with respect to the annular clamping region (166) configured to circularly excise the heart valve, wherein the slidable cutting element (160) is displaceable within an annulus of the annular clamping zone region (166)

Giant Circumflex Coronary Artery Fistula Draining into the Coronary Sinus

Coronary artery fistulas are rare congenital anomalies arising from an abnormal direct connection between any coronary arteries and a cardiac chamber, a great vessel or the coronary sinus. In this case report we present a rare case of a giant fistula between the f irst marginal branch of the circumflex coronary artery and the coronary sinus in a patient symptomatic for dyspnea and palpitation. A selective coronary angiography revealed the presence of a fistula between a coronary artery and the coronary sinus. A contrast-enhanced ECG-gated multi-doctor computed tomography confirmed the presence of a giant coronary artery fistula between the first obtuse marginal branch of the circumflex coronary artery and coronary sinus. Due to the rapid progression of the fistula diameter and symptoms, the patient underwent to a surgical closure of the fistula. At six months follow up, the patient was in excellent condition and asymptomatic for dyspnea, palpitation or chest pain. A control contrast-enhanced ECG-gated multi-dector computed tomography showed a complete closure of the fistula without residual shunt

Abrupt Suppression of Electroencephalographic Activity Due to Acute Hypercapnic Event Under Cardiopulmonary Bypass Detected by the NeuroSENSE Depth-of-Anesthesia Monitor.

NEUROLOGIC COMPLICATIONS still are a major concern after cardiac surgery.1 Moreover, the pathophysiology of neurocognitive function after cardiac surgery remains complex.2 The most currently used noninvasive brain monitors during cardiac surgery are, on one hand, the processed electroencephalogram (EEG) monitors and, on the other hand, the cerebral oximetry monitors providing regional cerebral oxygen saturation (rScO2) by near-infrared spectroscopy technology. The use of these monitors recently has been recommended,3 and their combination gives complimentary information that is useful for improving patient care. [...

Mitral valve repair for endocarditis.

Many authors have reported their results of mitral valve (MV) repair (MVr) in acute and healed endocarditis. However, the results published by different authors highlight the fact that the reparability rate for this indication remains low. Over the last three decades, our group has adopted an early and repair-oriented approach to infective endocarditis with the objective to improve the repair rate and the long-term results.‬ ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬ In this paper, we describe our institutional experience on mitral valve repair for infective endocarditis.‬‬‬‬‬‬‬‬‬‬‬‬ Data for this paper were extracted from our institutional database on heart valve disease. From 1991 to 2015, 160 consecutive patients in our institution underwent MV surgery for active IE on native MV. The median follow-up was 122 months. This study was approved by the institutional ethics review board, and written informed consent was waived for this study given its retrospective design. Hospital mortality was 11.6% (n = 18). Early MV reoperation before hospital discharge was required in five (3.1%) patients. At 5, 10, and 15 years, overall survival in the MVr for endocarditis in the group was 79% ± 4%, 65% ± 5%, 57% ± 6%, respectively. Freedom from reoperation at 5, 10, and 15 years was 95% ± 2%, 88% ± 4%, and 81% ± 6%, respectively. Mitral infective endocarditis is an insidious pathology and his surgical approach can be challenging. An early and repair-oriented surgical approach can allow to improve reparability rates with good long-term durability and a low recurrence rate of endocarditis

Pulmonary Autograft Sinus Muscular Inclusion: A Relative Contraindication for Ross Procedure.

No abstract availabl