Endoscopic forceps with prongs and related methods

Methods and surgical devices are described that can endoscopially manipulate a length of a suture. A forceps instrument is endoscopically introduced into the body. The forceps instrument includes opposing grasping members having respective pairs of spaced-apart prongs that extend away from the respective grasping members. Each pair of prongs defines an opening therebetween. A length of suture is grasped using the forceps instrument such that the suture is captured by the pairs of prongs and a portion of the suture extends across the openings defined by the pairs of prongs. The portion of the suture that extends across the openings is grasped with another surgical instrument

Endoscopic cardiac retractors with folding components configured for insertion using minimally invasive access ports and related methods

PDF Is patent applicationCardiac retractors include a rod and a foldable blade that can be introduced using minimally invasive access ports such that provided by an intra-thoracic cavity cannula. The rod can be integral to the blade or may be releasably attached in situ. The devices may be sized and configured to reside in situ proximate the mitral valve site at a left atria to splint open (lift a roof of) the mitral valve in response to robotic controlled direction of a surgeon for a mitral valve repair during a closed chest minimally invasive cardiac surgery

Factors Associated with Discharge to a Skilled Nursing Facility after Transcatheter Aortic Valve Replacement Surgery

An assumption regarding transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for treating aortic stenosis, is that patients remain at, or near baseline and soon return to their presurgical home to resume activities of daily living. However, this does not consistently occur. The purpose of this study was to identify preoperative factors that optimally predict discharge to a skilled nursing facility (SNF) after TAVR. Delineation of these conditions is an important step in developing a risk stratification model to assist in making informed decisions. Data was extracted from the American College of Cardiology (ACC) transcatheter valve therapy (TVT) registry and the Society of Thoracic Surgeons (STS) database on 285 patients discharged from 2012–2017 at a tertiary referral heart institute located in the southeastern region of the United States. An analysis of assessment, clinical and demographic variables was used to estimate relative risk (RR) of discharge to a SNF. The majority of participants were female (55%) and white (84%), with a median age of 82 years (interquartile range = 9). Approximately 27% (n = 77) were discharged to a SNF. Age > 75 years (RR = 2.3, p = 0.0026), female (RR = 1.6, p = 0.019), 5-meter walk test (5MWT) >7 s (RR = 2.0, p = 0.0002) and not using home oxygen (RR = 2.9, p = 0.0084) were identified as independent predictive factors for discharge to a SNF. We report a parsimonious risk-stratification model that estimates the probability of being discharged to a SNF following TAVR. Our findings will facilitate making informed treatment decisions regarding this older patient population

Mirror glasses for minimally invasive surgery

金沢大学大学院医学系研究科Introduction: The operator performing minimally invasive surgery is prevented from seeing the whole field with both eyes by the restricted small thoracotomy incision. To overcome this problem, we developed mirror glasses. Methods: Use of these glasses was evaluated in terms of the time required for threading of sutures with endoscopic forceps. Three surgeon ligated thread a suture five times with and without use of the glasses in the box, and the mean time was calculated for each surgeon. Results: The time required for ligation (mean ± SD) was 24.2 ± 2.9 s with mirror glasses and 27.0 ± 2.5 s without the glasses (p = 0.01). Conclusion: The mirror glasses may be found useful for fine manipulation for minimally invasive surgery. © 2006 Springer Science+Business Media, LL

Unusual cause of myocardial infarction following transcatheter aortic valve replacement

Key Clinical Message Left coronary artery embolism from aortic valve leaflet tissue mass is a rare but potentially life‐threatening complication following transcatheter aortic valve replacement. It is important for interventional cardiologists to be aware of this rare complication for rapid identification and prompt treatment which is the key to a successful outcome. Abstract An 81‐year‐old female presented for elective transcatheter aortic valve replacement (TAVR) for severe low‐flow low‐gradient aortic stenosis. Immediately post‐procedure, she developed unexplained, persistent hypotension. There was no bleeding. There was no aortic injury. Activated clotting time was in therapeutic range. Coronary angiography revealed hazy filling defects in left anterior descending and left circumflex. Intravascular ultrasound showed heterogeneous, hypoechoic mass with mild calcification consistent with embolized valve leaflet tissue. This was treated with emergent percutaneous coronary intervention with excellent results. Left coronary artery embolism from aortic valve leaflet tissue is a rare, but potentially life‐threatening complication following TAVR. Prompt recognition is key to a successful outcome

Endoscopic cardiac retractors with folding components configured for insertion using minimally invasive access ports and related methods

Cardiac retractors include a rod and a foldable blade that can be introduced using minimally invasive access ports such that provided by an intra-thoracic cavity cannula. The rod can be integral to the blade or may be releasably attached in situ. The devices may be sized and configured to reside in situ proximate the mitral valve site at a left atria to splint open (lift a roof of) the mitral valve in response to robotic controlled direction of a surgeon for a mitral valve repair during a closed chest minimally invasive cardiac surgery

Endoscopic forceps with prongs and related methods

Methods and surgical devices are described that can endoscopially manipulate a length of a suture. A forceps instrument is endoscopically introduced into the body. The forceps instrument includes opposing grasping members having respective pairs of spaced-apart prongs that extend away from the respective grasping members. Each pair of prongs defines an opening therebetween. A length of suture is grasped using the forceps instrument such that the suture is captured by the pairs of prongs and a portion of the suture extends across the openings defined by the pairs of prongs. The portion of the suture that extends across the openings is grasped with another surgical instrument

Factors Associated with Discharge to a Skilled Nursing Facility after Transcatheter Aortic Valve Replacement Surgery

An assumption regarding transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for treating aortic stenosis, is that patients remain at, or near baseline and soon return to their presurgical home to resume activities of daily living. However, this does not consistently occur. The purpose of this study was to identify preoperative factors that optimally predict discharge to a skilled nursing facility (SNF) after TAVR. Delineation of these conditions is an important step in developing a risk stratification model to assist in making informed decisions. Data was extracted from the American College of Cardiology (ACC) transcatheter valve therapy (TVT) registry and the Society of Thoracic Surgeons (STS) database on 285 patients discharged from 2012--2017 at a tertiary referral heart institute located in the southeastern region of the United States. An analysis of assessment, clinical and demographic variables was used to estimate relative risk (RR) of discharge to a SNF. The majority of participants were female (55%) and white (84%), with a median age of 82 years (interquartile range = 9). Approximately 27% (n = 77) were discharged to a SNF. Age > 75 years (RR = 2.3, p = 0.0026), female (RR = 1.6, p = 0.019), 5-meter walk test (5MWT) >7 s (RR = 2.0, p = 0.0002) and not using home oxygen (RR = 2.9, p = 0.0084) were identified as independent predictive factors for discharge to a SNF. We report a parsimonious risk-stratification model that estimates the probability of being discharged to a SNF following TAVR. Our findings will facilitate making informed treatment decisions regarding this older patient population