OBJECTIVES: In an effort to maintain the technical aspects of traditional prosthetic surgical aortic valve replacement (AVR) while reducing invasiveness and facilitate options for concomitant operations, transaxillary lateral mini-thoracotomy endoscopic robotic-assisted aortic valve replacement (RAVR) has been introduced. The present data highlight the contemporary international collaborative experience. METHODS: All consecutive patients undergoing standardized RAVR across 10 international sites (1/2020-7/2024) were evaluated using a central database with 1 year follow-up. RESULTS: A total of 300 patients were analysed with a median predicted risk of 1.6% with aortic stenosis in 85.7%, nearly half with bicuspid valves. Biological prostheses were implanted in 220 (73.3%) with a median valve size 23 mm, 10% receiving aortic root enlargement, with 17% of all patients undergoing concomitant procedures. Median cross-clamp 120 min with no conversions to sternotomy. Median length of stay was 5 days, 4.3% with prolonged ventilation, 1.7% renal failure, 1.0% stroke and 8.3% required re-thoracotomy for evacuation of haemothorax. There were two 30-day operative mortalities (0.7%). The new permanent pacemaker rate for the full cohort was 2.6%. Of 163 patients with complete 1-year clinical and echocardiographic follow-up, mean aortic valve gradient was 10 mmHg and all but 2 patients (1.2%) had trace to no prosthetic or paravalvular insufficiency. CONCLUSIONS: RAVR is safe and effective, providing the reproducible benefits of surgical AVR while affording a less invasive approach that permits the opportunity for concomitant procedures. For low and intermediate risk patients with aortic valve disease, RAVR is a potential reproducible alternative for patients and heart teams.
- MeSH
- aortální chlopeň * chirurgie MeSH
- aortální stenóza * chirurgie MeSH
- chirurgická náhrada chlopně * metody škodlivé účinky mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- následné studie MeSH
- roboticky asistované výkony * metody škodlivé účinky mortalita statistika a číselné údaje MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční chlopně umělé MeSH
- torakotomie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: Simulation-based training has gained distinction in cardiothoracic surgery as robotic-assisted cardiac procedures evolve. Despite the increasing use of wet lab simulators, the effectiveness of these training methods and skill acquisition rates remain poorly understood. OBJECTIVES: This study aimed to compare learning curves and assess the robotic cardiac surgical skill acquisition rate for cardiac and noncardiac surgeons who had no robotic experience in a wet lab simulation setting. METHODS: In this prospective cohort study, participants practiced 3 robotic tasks in a porcine model: left atriotomy closure, internal thoracic artery harvesting and mitral annular suturing. Participants were novice robotic cardiac and noncardiac surgeons alongside experienced robotic cardiac surgeons who established performance benchmarks. Performance was evaluated using the time-based score and modified global evaluative assessment of robotic skills (mGEARS). RESULTS: The participants were 15 novice surgeons (7 cardiac; 8 noncardiac) and 4 experienced robotic surgeons. Most novices reached mastery in 52 (±22) min for atrial closure, 32 (±18) for internal thoracic artery harvesting and 34 (±12) for mitral stitches, with no significant differences between the cardiac and noncardiac surgeons. However, for mGEARS, noncardiac novices faced more challenges in internal thoracic artery harvesting. The Thurstone learning curve model indicated no significant difference in the learning rates between the groups. CONCLUSIONS: Wet lab simulation facilitates the rapid acquisition of robotic cardiac surgical skills to expert levels, irrespective of surgeons' experience in open cardiac surgery. These findings support the use of wet lab simulators for standardized, competency-based training in robotic cardiac surgery.
- Publikační typ
- časopisecké články MeSH
- MeSH
- hrudní chirurgie * trendy organizace a řízení MeSH
- kardiochirurgické výkony * trendy statistika a číselné údaje MeSH
- lidé MeSH
- předpověď MeSH
- roboticky asistované výkony * trendy statistika a číselné údaje MeSH
- společnosti lékařské * trendy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- úvodníky MeSH
- Geografické názvy
- Evropa MeSH
Robotic coronary and intra-cardiac surgery has been available for more than 25 years. In this period, multiple studies have demonstrated the beneficial effects of robotic surgery over conventional open surgery. Throughout the years, technical developments have enabled us to perform totally endoscopic coronary artery bypass (TECAB) grafting. But these techniques remained in the hands of a small group of pioneers because of a lack of structured training programs and the absence of long-term results at that time. Currently, a renewed interest and a wide dispersion of robotic platforms, thanks to use of robotics in other disciplines, has led to an exponential increase in robotic cardiac centers both in Europe and USA. Nonetheless, this increase was slowed down in Europe as a result of the uncertainty introduced by the implementation of a revised regulatory framework for medical devices [Regulation 2017/745, 'Medical Device Regulation' ('MDR')]. The MDR was introduced with the goal of increasing patient safety and supporting innovation. Implementing the MDR has proven to be exceptionally challenging and risks to the supply of essential devices have been identified. Changes to both regulatory and market dynamics led to a circumstance where the only available robotic platform for cardiac surgery decided to cease marketing of essential accessories for conducting surgery. This resulted in the disappearance of dedicated tools such as the Endowrist stabilizer, essential for TECAB, and the atrial retractor which is essential for intra-cardiac surgery. In the mean-time, further clinical evidence was published demonstrating the superiority of robotic cardiac surgery over other minimally invasive approaches. This has demonstrated the need to better define the clinical evidence requirements for regulatory purposes to ensure that dedicated tools for evidence-based interventions in robotic coronary surgery remain available such that TECAB can continue in Europe.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVES: Both aortic root remodelling and aortic valve (AV) reimplantation have been used for valve-sparing root replacement in patients with aortic root aneurysm with or without aortic regurgitation. There is no clear evidence to support one technique over the another. This study aimed to compare remodelling with basal ring annuloplasty versus reimplantation on a multicentre level with the use of propensity-score matching. METHODS: This was a retrospective international multicentre study of patients undergoing remodelling or reimplantation between 2010 and 2021. Twenty-three preoperative covariates (including root dimensions and valve characteristics) were used for propensity-score matching. Perioperative outcomes were analysed along with longer-term freedom from AV reoperation/reintervention and other major valve-related events. RESULTS: Throughout the study period, 297 patients underwent remodelling and 281 had reimplantation. Using propensity-score matching, 112 pairs were selected and further compared. We did not find a statistically significant difference in perioperative outcomes between the matched groups. Patients after remodelling had significantly higher reintervention risk than after reimplantation over the median follow-up of 6 years (P = 0.016). The remodelling technique (P = 0.02), need for decalcification (P = 0.03) and degree of immediate postoperative AV regurgitation (P < 0.001) were defined as independent risk factors for later AV reintervention. After exclusion of patients with worse than mild AV regurgitation immediately after repair, both techniques functioned comparably (P = 0.089). CONCLUSIONS: AV reimplantation was associated with better valve function in longer-term postoperatively than remodelling. If optimal immediate repair outcome was achieved, both techniques provided comparable AV function.
- MeSH
- anuloplastika srdeční chlopně metody MeSH
- aortální chlopeň * chirurgie MeSH
- aortální insuficience * chirurgie MeSH
- chirurgická náhrada chlopně metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- reoperace statistika a číselné údaje MeSH
- replantace * metody MeSH
- retrospektivní studie MeSH
- senioři MeSH
- tendenční skóre * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
Pooperační ranné komplikace revaskularizačních výkonů v tříslech zahrnují velmi často komplikace spojené s poraněním lymfatického systému jako lymfokélu a lymforheu s následnými lokálními infekčními komplikacemi hrozícími infekcí protetických štěpů. Prezentujeme kazuistiku úspěšného ošetření pooperační lymfokély s následnou lymfatickou píštělí a dehiscencí operační rány pomocí intranodální embolizace poraněné lymfatické uzliny tkáňovým lepidlem Histoacryl.
Early postoperative wound complications in revascularization procedures in the groin very often include complications associated with injury to the lymphatic system such as lymphocele and lymphorrhea with subsequent local infectious complications and the risk of infection of prosthetic grafts. We present a case report of successful treatment of postoperative lymphocele with subsequent lymphatic fistula and dehiscence of the surgical wound by intranodal embolization of the injured lymph node with Histoacryl tissue glue.
- MeSH
- cévní píštěle terapie MeSH
- chronická kritická ischemie končetin chirurgie komplikace MeSH
- dehiscence operační rány terapie MeSH
- lidé MeSH
- lymfatické uzliny chirurgie diagnostické zobrazování MeSH
- lymfografie metody MeSH
- lymfokela * diagnostické zobrazování terapie MeSH
- pooperační komplikace diagnostické zobrazování terapie MeSH
- punkce metody MeSH
- senioři MeSH
- terapeutická embolizace * metody MeSH
- tkáňová adheziva terapeutické užití MeSH
- transplantace cév metody škodlivé účinky MeSH
- třísla chirurgie patologie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- aortální chlopeň diagnostické zobrazování chirurgie MeSH
- chirurgická náhrada chlopně * škodlivé účinky MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- roboticky asistované výkony * MeSH
- srdeční chlopně umělé * MeSH
- transkatetrální implantace aortální chlopně * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodníky MeSH
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.
- Publikační typ
- časopisecké články MeSH
Surgical treatment for mitral regurgitation has undergone dramatic development in the last four decades. To preserve the patient's native valve and restore its proper function with conserving surgery is currently a clear priority in the surgical setting. This procedure is typically referred to as mitral valve repair. Currently, less invasive surgical approaches to the mitral valve are increasingly used that offer patients, in addition to being less invasive, stability and predictability of classic surgical repair based on the principles of modern mitral valve surgery. Video-assisted right-sided mini-thoracotomy or robotic surgery are the most commonly used approaches. In large patient cohorts, these approaches had similar surgical outcomes in terms of valve repairability and displayed lower rates of early complications, lower rates of postoperative atrial fibrillation, lower blood product utilization, shorter duration of mechanical ventilation, shorter intensive care unit stay, and shorter overall duration of hospital stay. Subsequently, a rapid return to normal activities is possible. This is attractive for young patients, particularly in the light of the new guidelines of professional societies wherein the indications for conserving surgery shift to groups of asymptomatic patients and the procedures are preventive in nature. In future, these approaches can be expected to become the standard of care for these patients, further highlighting the need to create specialized centres of excellence for surgical treatment of the mitral valve.
Chirurgická léčba mitrální regurgitace prošla za poslední čtyři desetiletí bouřlivým vývojem. Dnes je při chirurgické léčbě jednoznačnou prioritou ponechat pacientovu vlastní chlopeň a obnovit její správnou funkci záchovnou operací. Tento postup se nejčastěji označuje jako plastika mitrální chlopně. V současné době jsou stále častěji uplatňovány méně invazivní chirurgické přístupy k mitrální chlopni, které nabízejí nemocným, kromě menší invazivity, zároveň i stabilitu a predikabilitu klasické chirurgické plastiky založené na principech moderní chirurgie mitrální chlopně. Nejčastěji používané přístupy jsou videoasistovaný přístup cestou pravostranné limitované torakotomie, případně robotický přístup. Tyto přístupy ve velkých souborech pacientů dosahují stejných chirurgických výsledků, co se týká reparability chlopně, a ukazují nižší výskyt raných komplikací, nižší výskyt pooperační fibrilace síní, menší spotřebu krevních derivátů, kratší dobu umělé plicní ventilace, kratší pobyt na jednotce intenzivní péče a kratší dobu celkové hospitalizace. Je posléze umožněn i rychlý návrat k běžným aktivitám. Toto je pro mladé nemocné atraktivní především ve světle nových doporučení odborných společností, kdy se indikace pro záchovný výkon posouvají do skupin asymptomatických pacientů a výkony mají preventivní charakter. Do budoucna lze předpokládat, že se tyto přístupy stanou standardem péče o tyto nemocné a ještě více zvýrazní potřebu vytvářet specializovaná „center of excellence“ pro chirurgickou léčbu mitrální chlopně.
BACKGROUND: Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)-derived indices and natriuretic peptides (BNP [brain natriuretic peptide] or NT-proBNP [N-terminnal pro-B type natriuretic peptide]) to predict early disease decompensation in asymptomatic severe AR. METHODS: This prospective and multicenter study included asymptomatic patients with severe AR, preserved left ventricular ejection fraction (>50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines. RESULTS: The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041-1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all P<0.05). However, a combined model including one parameter of AR assessment (MRI regurgitant volume or regurgitant fraction or 3-dimensional vena contracta area), 1 parameter of left ventricular remodeling (MRI left ventricular end-diastolic volume index or echocardiography 2-dimensional global longitudinal strain or E wave), and BNP showed significantly higher predictive accuracy (area under the curve, 0.74-0.81) than any parameter alone (area under the curve, 0.61-0.72). These findings were confirmed in the validation cohort (n=100 patients, 38 end points). CONCLUSIONS: In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02910349.
- MeSH
- aortální insuficience * diagnostické zobrazování etiologie chirurgie MeSH
- dospělí MeSH
- echokardiografie MeSH
- funkce levé komory srdeční MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- natriuretický peptid typu B MeSH
- tepový objem MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
