1,720,993 research outputs found
Reparative surgery versus bileaflet prosthetic replacement in rheumatic mitral disease: long-term follow-up
No full textThe use of robotic technology in the LAST operation
No full textBACKGROUND:
The LAST operation represents a good option for single left anterior descending artery (LAD) revascularization. We report our preliminary experience with the LAST operation performed with the aid of the "da Vinci" Intuitive robotic system.
METHODS:
From January 2000 to May 2001, 12 patients (11 males and 1 female, mean age 62 +/- 8 years) underwent the LAST operation. All patients had a proximal LAD lesion either not suitable for coronary angioplasty or unsuccessfully treated at coronary angioplasty previously. The mean preoperative ejection fraction was 55 +/- 5%. In all patients, left internal mammary artery (LIMA) harvesting was carried out endoscopically using robotic technology. After heparin administration the LIMA was distally divided to check the adequacy of the blood flow. An incision of about 6 cm was then made in the appropriate intercostal space and the LAD was exposed using a special costal retractor. Following the insertion of a temporary intracoronary shunt, the LIMA was anastomosed to the LAD.
RESULTS:
No hospital or delayed death occurred. Uneventful conversion to midline sternotomy was necessary in one patient who developed ischemic changes and hemodynamic instability. One patient had a revision for postoperative bleeding. All patients were discharged within the first postoperative week and in 4 of them optimal patency of the LIMA graft was angiographically documented.
CONCLUSIONS:
The use of robotic technology seems to overcome all the drawbacks associated with the LAST operation and enhances the role of minimally invasive surgery in coronary artery revascularization
Totally endocsopic atrial septal defect closure with a robotic system: Experience with seven cases
No full textBackground: 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"TM 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
Long-term results of apico-aortic valved conduit for severe idiopathic hypertrophic subaortic stenosis
No full text
Prosthetic aortic valve thrombosis: Incidence, pathological findings and surgical treatment
No full textBACKGROUND. The authors report their experience on the diagnosis, pathological findings and surgical treatment of prosthetic aortic valve thrombosis. METHODS. Between January 1976 and June 1998, 1289 mechanical prostheses were implanted in aortic position at our institution: a prosthetic obstruction was found in 12 cases. Thrombolysis was performed in two cases and as a result, pathological findings were not available and the patients were excluded from the study. Ten patients underwent surgical treatment. RESULTS. Thrombectomy was performed in one case and prosthetic replacement was done in 9 patients. One patient died postoperatively of low-output syndrome, the others were discharged and no recurrence of thrombosis has been observed at follow-up. Primary thrombosis was found in 6 cases, and pannus formation was observed in 4 patients. All patients with primary thrombosis had a history of poor anticoagulation. Patients with pannus formation had a tilting disc prosthesis. CONCLUSIONS. Use of bileaflet prostheses and adequate anticoagulation can further lessen the incidence of this dreadful complication
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