Evaluation of the MMI Symani robotic microsurgical system for coronary-bypass anastomoses in a cadaveric porcine model.

The MMI Symani is a recently approved robotic microsurgical system for surgical procedures in adults. The system enables the surgeon to create microanastomoses. Clinical applications so far include lymphatic vessels surgery and the creation of special flap plastics.

Case Report: The woman with the big heart-an imaging-guided attempt of surgical reduction.

In a female patient with acute cardiac decompensation, an auxiliary finding of a giant left atrium emerged. The surgical therapy of the atrial reduction, in addition to a mitral valve replacement and a coronary artery bypass grafting, is hereby presented.

Long-term follow-up of patients with complex coronary artery disease treated with minimally invasive direct coronary artery bypass.

Background: Patients with complex coronary artery disease (CAD) may benefit from surgical myocardial revascularization but weighing the risk of peri-operative complications against the expected merit is difficult. Minimally invasive direct artery bypass (MIDCAB) procedures are less invasive, provide the prognostic advantage of operative revascularization of the left anterior descending artery and may be integrated in hybrid strategies. Herein, the outcomes between patients with coronary 1-vessel disease (1-VD) and patients with 2-VD and 3-VD after MIDCAB procedures were compared in this single-center study.

Robot-Assisted Surgery of an Iliac Artery Aneurysm: A Case Report.

Robot-assisted surgery has not yet been able to establish itself for vascular surgery. However, the preconditions for robot-assisted vascular interventions have changed fundamentally over the past years because of technological advances and extensive experience in other surgical disciplines. Hence, we describe a robot-assisted repair of an iliac artery aneurysm using a late-generation robotic platform.

Robotic-assisted abdominal aortic surgery: evidence and techniques.

In various disciplines, robotic-assisted surgery is a well-proven routine procedure, but have never been established in vascular surgery so far. This review summarizes the results to date of robotic-assisted abdominal aortic surgery (RAAS) in the treatment of aorto-iliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA). Web-based literature search of robotic-assisted surgical procedures on the abdominal aorta and iliac arteries between 1990 and 2020 including the Cochrane Library, OVID Medline, Embase, and PubMed medical databases.

Repair of the descending thoracic aorta using minimally invasive endoscopic Robot-assisted surgery: a feasibility study with the DaVinci XI system in a cadaver model.

Development of minimally invasive techniques has led to the clinical routine application of Robot-assisted surgery. Here, we demonstrate for the first time Robotic-assisted surgery (DaVinci XI) of the descending thoracic aorta in a Thiel cadaver model and discuss its potential value in the endovascular era.

Minimally Invasive Direct Coronary Artery Bypass in High-Risk Patients with Multivessel Disease.

Background:  High-risk patients with multivessel disease (MVD) including a complex stenosis of the left anterior descending coronary may not be ideal candidates for guideline compliant therapy by coronary artery bypass grafting (CABG) regarding invasiveness and perioperative complications. However, they may benefit from minimally invasive direct coronary artery bypass (MIDCAB) grafting and hybrid revascularization (HCR).

Methods:  A logistic European system for cardiac operative risk evaluation score (logES) >10% defined high risk.

Is total arch replacement associated with an increased risk after acute type A dissection?

Background: The surgical strategy for acute type A aortic dissection (AADA) usually consists of reconstruction of the tear-lesion in the affected part of the ascending aorta. The optimal strategy either to replace the ascending aorta (AAR) or to replace the ascending aorta and the total aortic arch (TAAR) is still under debate. Our study compares the 30-day mortality between AAR and TAAR in AADA surgery.

Sex-specific risk factors for early mortality and survival after surgery of acute aortic dissection type a: a retrospective observational study.

Background: Although gender-related disparities in cardiovascular surgery have been investigated extensively in the past decades, knowledge about the impact of gender on outcomes after surgery for acute aortic dissection type A (AADA) is sparse. This study investigated the impact of gender on early morbidity and mortality and follow-up outcome in patients after surgery for AADA and to analyze gender-related risk factors for 30-day mortality.

Methods: This retrospective study included 368 consecutive patients (male 65.

Sex-specific outcome after minimally invasive direct coronary artery bypass for single-vessel disease.

Objectives: Female gender is reported as an independent risk factor for a poor outcome after coronary artery bypass grafting. We analysed the influence of gender on surgical outcome in patients with single-vessel disease undergoing minimally invasive direct coronary artery bypass (MIDCAB).

Methods: From January 1998 to December 2016, a total of 607 consecutive patients with single-vessel disease (31.

Impact of Patient-Prosthesis Mismatch following Aortic Valve Replacement on Long-Term Survival and Quality of Life.

Background: The impact of patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) on long-term survival and quality of life (QoL) remains controversial. The objective of this study was to evaluate the impact of PPM on long-term survival and QoL in a large cohort of patients treated with isolated stented biological AVR in a single-center experience.

Methods: We analyzed data of 632 consecutive patients following isolated stented biological AVR between 2007 and 2012 at our institution.

Extracorporeal membrane oxygenation for acute respiratory distress syndrome in adults: an analysis of differences between survivors and non-survivors.

Objectives: Over the last decade, extracorporeal membrane oxygenation (ECMO) has become a promising option for patients with severe acute respiratory distress syndrome (ARDS). In this single-center observational cohort study, data from a patient group with severe ARDS treated with ECMO was analyzed.

Methods: Data from 46 patients [median age 54 years (18 to 72), male: 65.

Prevention of surgical site sternal infections in cardiac surgery: a two-centre prospective randomized controlled study.

Objectives: Surgical site infection (SSI) of the sternum is a devastating complication in cardiac surgery. The aim of this prospective randomized controlled two-centre clinical study was to compare the use of a gentamicin-collagen sponge (Genta-Coll® resorb) and of a cyanoacrylate-based microbial skin sealant (InteguSeal®) on the SSI rate of the sternum.

Methods: We analysed data from 996 consecutive patients following isolated coronary artery bypass grafting between 2012 and 2014.

Short- and long-term follow-up after minimally invasive direct coronary artery bypass in octogenarians.

Objectives: Demographic changes lead to a rising incidence of octogenarians undergoing surgical revascularization of coronary artery disease. Minimally invasive direct coronary artery bypass (MIDCAB) represents a surgical treatment with reduced trauma and without the use of cardiopulmonary bypass. The aim of this study was to evaluate short- and long-term outcomes after MIDCAB in octogenarians.

Impact of Gender on Outcome in Octogenarians after Coronary Artery Bypass Grafting.

 Increasing life expectancy makes cardiac surgery in octogenarians not very uncommon. In this study, the impact of gender on outcome of octogenarians after coronary artery bypass grafting (CABG) was assessed.  We retrospectively studied 485 octogenarians (176 females: mean age 82.

Transatrial Cannulation of the Left Ventricle for Acute Type A Aortic Dissection: A 5-Year Experience.

Background: Acute type A aortic dissection (AAD) is a life-threatening disorder with a high rate of mortality and complications. All cannulation techniques currently used to establish arterial flow for cardiopulmonary bypass are associated with a considerable risk of organ malperfusion, stroke, or access site trauma. Here, we report the impact of transatrial cannulation of the left ventricle on patient outcome after surgical treatment of AAD.

Off-pump coronary artery bypass prevents visceral organ damage.

Objectives: Visceral malperfusion after coronary artery bypass grafting (CABG) results in high morbidity and mortality. This study was designed to evaluate the effect of CABG performed by surgical techniques on visceral perfusion and function.

Methods: Pigs (n = 28) were studied in four groups: I.

Impact of patient-prosthesis mismatch following aortic valve replacement on short-term survival: a retrospective single center analysis of 632 consecutive patients with isolated stented biological aortic valve replacement.

Objectives: The impact of patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) on short-term and long-term mortality remains controversial. The objective of this study was to evaluate the incidence and severity of PPM and its impact on short-term survival in a large cohort of patients treated with isolated stented biological AVR in a single institution.

Methods: We analyzed retrospectively data of 632 consecutive patients with aortic stenosis undergoing isolated stented biological AVR between January 2007 and February 2012 at our institution.

Minimally invasive direct coronary artery bypass in a child with an occlusion of left main coronary artery after arterial switch operation.

We present a case of a 13-year old girl experiencing recurring angina pectoris due to an occlusion of the left main coronary artery after arterial switch operation in infancy. To avoid a repeat sternotomy and the use of cardiopulmonary bypass, the patient underwent uncomplicated operative myocardial revascularization in the minimally invasive direct coronary artery bypass (MIDCAB) technique.

Highly flexible nitinol mesh to encase aortocoronary saphenous vein grafts: first clinical experiences and angiographic results nine months postoperatively.

Saphenous vein graft patency is frequently limited by degeneration. Experimental studies have indicated that rigid external support of venous grafts by a flexible, tubular nitinol mesh may improve graft patency. The study presented was part of a prospective, randomized, multicenter first-in-man trial investigating the safety and effectiveness of nitinol-supported venous grafts in coronary artery bypass graft (CABG) surgery.

Does patient-prosthesis mismatch influence the results of combined aortic valve replacement and coronary bypass grafting?

Background: Combined aortic valve replacement and coronary revascularisation is becoming more frequent. Patient-prosthesis mismatch (PPM) as an additional risk factor may potentially affect the early and late outcome.

Aim: To evaluate the impact of PPM on early and mid-term clinical results including quality of life in patients undergoing combined surgical treatment of coronary artery disease and aortic valve defects.

Cerebral metabolism during deep hypothermic circulatory arrest vs moderate hypothermic selective cerebral perfusion in a piglet model: a microdialysis study.

Background: Few data exist regarding antegrade selective cerebral perfusion (ASCP) and its application in newborn and juvenile patients. Clinical data suggest ASCP alone to be superior to deep hypothermic circulatory arrest (DHCA); however, the effects of moderate hypothermia during ASCP on cerebral metabolism in this patient population are still unclear.

Methods: After obtaining the approval from animal investigation committee, 16 piglets were randomly assigned to circulatory arrest combined with either ASCP at 27 degrees C or DHCA at 18 degrees C for 90 min.

Measurement of blood flow index during antegrade selective cerebral perfusion with near-infrared spectroscopy in newborn piglets.

Background: Neonates with complex congenital heart defects have traditionally undergone surgery during deep hypothermic cardiac arrest (HCA). Selective cerebral perfusion (SCP) is thought to minimize ischemic brain injury by providing adequate cerebral blood flow. We investigated SCP with different flow rates compared with HCA with respect to cerebral perfusion and tissue oxygenation as assessed by near-infrared spectroscopy.

Durability of bioprosthetic cardiac valves.

Introduction: The choice of type of heart valve prosthesis is determined by the patient's age since bioprostheses have a limited lifespan. This article reviews current recommendations and the literature on cardiac valve replacement.

Methods: Selective literature search in Medline/PubMed back to 1996 and review of current national and international recommendations from specialist societies.