Association of operative risk with the outcome of concomitant Cox Maze procedure: A comparison of results across risk groups

Ad, Niv; Holmes, Sari D.; Pritchard, Graciela; Shuman, Deborah J.

doi:10.1016/j.jtcvs.2014.05.039

Cited by 40 publications

(42 citation statements)

References 16 publications

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“…Our series shows excellent outcomes in patients who had a lone RMVP with almost zero mortality and very acceptable morbidity. Conversely, compared to other series, we did find that by adding a maze, the mortality, myocardial infarction, and stroke rates increased significantly (46,47). Throughout our experience, we have used all types of ablative energy sources including unipolar radiofrequency, bipolar radiofrequency, microwave, and cryothermia.…”

Section: Conclusion and Perspectivementioning

confidence: 75%

Robotic mitral valve surgery: overview, methodology, results, and perspective

Chitwood¹

2016

Ann. Cardiothorac. Surg.

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Robotic mitral valve repair began in 1998 and has advanced remarkably. It arose from an interest in reducing patient trauma by operating through smaller incisions with videoscopic assistance. In the United States, following two clinical trials, the FDA approved the daVinci Surgical System in 2002 for intra-cardiac surgery. This device has undergone three iterations, eventuating in the current daVinci XI. At present it is the only robotic device approved for mitral valve surgery. Many larger centers have adopted its use as part of their routine mitral valve repair armamentarium. Although these operations have longer perfusion and arrest times, complications have been either similar or less than other traditional methods. Preoperative screening is paramount and leads to optimal patient selection and outcomes. There are clear contraindications, both relative and absolute, that must be considered. Three-dimensional (3D) echocardiographic studies optimally guide surgeons in operative planning. Herein, we describe the selection criteria as well as our operative management during a robotic mitral valve repair. Major complications are detailed with tips to avoid their occurrence. Operative outcomes from the author's series as well as those from the largest experiences in the United States are described. They show that robotic mitral valve repair is safe and effective, as well as economically reasonable due to lower costs of hospitalization. Thus, the future of this operative technique is bright for centers adopting the "heart team" approach, adequate clinical volume and a dedicated and experienced mitral repair surgeon. Keynote Lecture SeriesHe who is fixed to a star does not change his mind.--Leonardo da Vinci Evolutionary overviewWith the development and improvement of endoscopic vision in the late 1970s, the notion of laparoscopic operations was spawned and then developed rapidly, despite early reservations by most surgeons. This skepticism was gradually overcome as many traditional general surgical, gynecological and urological operations were replaced rapidly by less invasive and/or endoscopic operations. During this era, cardiac surgery had evolved so well using sternotomy incisions that there seemed to be no incentive for cardiac surgeons to adopt either secondary vision or less invasive incisions. Non-cardiac thoracic surgeons were the first to embrace this disruptive methodology and they proved that major pulmonary operations could be done safely and effectively using thoracoscopic techniques. The idea of minimally invasive cardiac surgery emanated from the "Heartport Era" with the development of new innovative aortic occlusive devices, long-shafted instruments and ports for cardiac access (1,2). These developments issued the clarion call that minimally invasive cardiac surgery was possible and that surgeons must begin

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Section: Conclusion and Perspectivementioning

confidence: 75%

Robotic mitral valve surgery: overview, methodology, results, and perspective

Chitwood¹

2016

Ann. Cardiothorac. Surg.

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“…Indeed even in the present day, the greatest potential to impact the overall burden of AF is in patients with concomitant cardiac disease who are already undergoing cardiac surgery (28). The development of a minimally invasive CMIV procedure has lessened the CPB time, cross-clamp time, operative risk, and overall morbidity of the Cox-Maze procedure while maintaining its efficacy, and these results hold true for patients with non-paroxysmal AF, high surgical risk (43), and those undergoing concomitant procedures (25). A major focus of our efforts should now be on patient and surgeon education to encourage more aggressive treatment of concomitant AF (44).…”

Section: Areas For Future Researchmentioning

confidence: 99%

Minimally invasive surgery for atrial fibrillation

Lancaster

Melby

Damiano

2016

Trends in Cardiovascular Medicine

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“…In this regard, we additionally used the adapted calculator to account the risks in the proposed multi-component operations, which has been suggested by G. Ambler et al This calculator also takes into considerationthe additional surgical procedures (CABG, Maze procedure, etc.). According to this calculator estimated risks of hospital mortality and total mortality were 5.5 (3.0, 7.3) and 8 (6,9) respectively (data presented as median with interquartile range).…”

Section: Patientsmentioning

confidence: 99%

“…Nowadays combined correction of multivalve disease with AF is rarely performed [5]. According to various data, the absence of surgical treatment of AF in patients with combined heart pathology reaches about 40-60%, leaving them at increased risk of stroke [6,7].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous surgical correction of atrial fibrillation and aortic valve replacement: immediate results after surgery

Bockeriа¹,

Bockeria²,

Санакоев³

et al. 2016

Russ. Open Med. J.

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Aim -To assess the results of simultaneous surgical correction of atrial fibrillation and aortic valve replacement. Materials and Methods -The retrospective analysis was held for the period of 2009-2016 of patients with atrial fibrillation (AF) and pathology of the aortic valve after combined operations. 68 patients were included in the study, the average age was 56 (51; 64) years; men 53%, women 47%. All patients were in III-IV functional class by NYHA classification. The duration of AF was 34 (24; 58) months. AF: persistent in 70,6%, paroxysmal in 29,4%. Calculated risks comprised: Euro Score II -3,8 (2,4; 5,6), the risk of in-hospital mortality and the risk of total mortality by Ambler -5,5 (3; 7,3) and 8 (6; 9), respectively. Results -The average number of simultaneous procedures per one patient was -4 (4; 4), minimum -3, maximum -5. In 100% cases was performed aortic valve and mitral valve correction and Maze IIIB procedure. CABG was performed in 20,6% of cases and tricuspid valve repair was performed in 67,6%. The total duration of operations was 6.3 ± 1.4 hours, the time of CPB: 208 (168; 224) min, aortic clamping time: 126 (119; 151) min. In-hospital mortality was 4.4%. The main non-lethal complications in the early postoperative period were heart failure, respiratory and renal insufficience, hemorrhage and transient neurological disorder. Conclusions -There are few data demonstrating experience in performing of such complex surgical cases due to the severity of patients and small number of institutions having such experience. In our series of hospital mortality observations correlated with the calculated and accounted for 4.4%, which is an acceptable result in this group of patients. Keywords: atrial fibrillation, aortic valve replacement, multivalve pathology of the heart.Cite as Bockeria LA, Bockeria OL, Sanakoev MK, Le TG, Satyukova AS, Ispiryan AYu, Klimchuk IY, Fatulaev ZF, Petrosyan AD, Shvartz VA. Simultaneous surgical correction of atrial fibrillation and aortic valve replacement: immediate results after surgery.

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Association of operative risk with the outcome of concomitant Cox Maze procedure: A comparison of results across risk groups

Abstract: The Cox maze III/IV procedure can be performed safely and effectively in patients with higher operative risk, who fare well when compared with lower-risk patients. The Cox maze III/IV procedure should be considered carefully in patients with a significant history of atrial fibrillation.

Cited by 40 publications

References 16 publications

Robotic mitral valve surgery: overview, methodology, results, and perspective

Robotic mitral valve surgery: overview, methodology, results, and perspective

Minimally invasive surgery for atrial fibrillation

Simultaneous surgical correction of atrial fibrillation and aortic valve replacement: immediate results after surgery

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