Seven Habits of Highly Effective Endoscopic Mitral Surgeons

Zacharias, Joseph; Perier, Patrick

doi:10.1177/1556984519888456

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…Aortic dissection and cannulation complications seemed to be avoided with more planning before surgery even in difficult cases (63). It is clear that with the introduction of the 3-dimension scopes that the view and vision of the surgical field has become much better together with depth perception and manual dexterity (66). This should encourage young surgeons to be more open to this new technology in teams that would elaborate more on a multidisciplinary approach in treatment (heart team) (67).…”

Section: Insights In Micsmentioning

confidence: 99%

Minimally invasive tricuspid valve surgery

Abdelbar¹,

Kenawy²,

Zacharias³

2021

J Thorac Dis

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Tricuspid valve disease carries a very unfavorable prognosis when medically treated. Despite that, surgical intervention is still underperformed for tricuspid valve disease due to the reported high morbidity and mortality from a sternotomy approach. This had led to a shift towards maximizing medical therapy for right ventricular failure and, as a result, a more significant delay in surgical referrals with surgical risks when patients are finally referred. Tricuspid valve patients usually have other co-morbidities resulting from their systemic venous congestion and low flow cardiac output. Minimally invasive tricuspid valve surgery provides less tissue injury and, as a result, less trauma during surgery. This provides a hope for both patients and treating doctors to be more open for providing this procedure with less complications. Isolated minimally invasive tricuspid valve surgery is still not performed as widely as expected. This can be partly due to the adverse outcomes historically labelled to tricuspid valve surgery or by the long journey of learning the surgical team would need to commit to with a minimal access approach. In this article we will review the perioperative pathway, and outcomes of isolated minimally invasive tricuspid valve surgery in the available English literature.

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Section: Insights In Micsmentioning

confidence: 99%

Minimally invasive tricuspid valve surgery

Abdelbar¹,

Kenawy²,

Zacharias³

2021

J Thorac Dis

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“…competed against) and might soon be redundant also made persuading others of its value difficult. Notwithstanding these competitive challenges, evolving research suggests that stents do not confer as long a result as originally expected, compared to coronary surgery (13) and given the increasing demand from patients and the vast need for treatment in the undeveloped world, MIS cardiac surgery does have a bright future if innovation is adopted widely (14) .…”

Section: Lack Of Financial Supportmentioning

confidence: 99%

“…They spoke of instilling pride in the team and making each professional feel ownership of their part in the surgery. Their approach reflected the four-step process of enrolment, preparation, trials and reflection (14) for implementing innovation but, as is evident was not smooth.…”

Section: The Theatre Teammentioning

confidence: 99%

Adoption of minimally invasive mitral valve surgery in the NHS. A blend of science and psychology.

Joffe¹,

Hunter

Casula³

et al. 2021

Preprint

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OBJECTIVES The objectives of this study were to understand the challenges faced by early adopters of MIS mitral surgery in the national health system in the United Kingdom. It was to (i) capture the significance of the scrutiny introduced by reporting surgeon specific results during the introduction of surgical innovation, (ii) understand how individual personality and behaviour helped these surgeons succeed despite, in many cases, little wider support, (iii) to help more surgeons adopt these patient-centred techniques. SETTING AND PARTICIPANTS The study is based on a qualitative exploration of the reported experiences of all ten early adopters of MIS cardiac surgery in the NHS between 2006-2016. Interviewees were recruited by invitation through their professional society (BISMICS). All interviewees consented to the process; ethical permission was not deemed necessary. RESULTS The experience of introducing surgical innovation into the NHS was unanimously noted to be difficult with few incentives and many systemic and institutional obstacles. Despite this there was a general belief in pushing forward with these patient centred procedures while accumulating the evidence to support it. CONCLUSIONS Individual determination, confidence, mental agility and self-reflection were seen as characteristics of those who were successful. All surgeons agreed that the reporting of surgeon specific results were not conducive to adoption of innovation in teams. Starting a new program as two surgeons appeared to help reduce perceived pressures. Surgical innovation and its early adoption are always likely to be difficult and needs to be recognised as such, within the NHS

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“…These certain clinical conditions are potentially harmful limitations for safe MVS via the right MT access type, making FS the sole, alternatively preferred, safe and quick access type in 45% of MV surgeries in almost all German centers [ 7 , 12 ]. Moreover, longer operative times and learning curves associated with the use of long-shafted instruments and endoscopic techniques still prevent the broad acceptance of less-invasive procedures [ 13 ]. In addition, MV repair rates in complex pathologies are generally based on institutional experience and may additionally limit the number of patients suitable for MIMVS via MT [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery

Oezpeker

Barbieri

Höfer

et al. 2023

JCDD

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Background: For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we developed a personalized, minimized-invasiveness algorithm for MVS. Methods: In this retrospective analysis, 517 elderly patients (≥70 years) were identified who had undergone MVS ± TV repair. MVS was performed via MT (n = 274), FS (n = 128) and PS (n = 115). The appropriate access type was defined according to several clinical patient conditions. Using uni- and multivariate regression models, we analyzed combined operative success (residual MV regurgitation, conversion to MV replacement or larger thoracic incisions); perioperative success (30-days mortality, thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation); and reoperation-free long-term survival. An additional EuroSCORE2 adjustment was performed to reduce the bias of clinical conditions between all access types. Results: The EuroSCORE2-adjusted Cox regression analysis showed significantly increased reoperation-free survival in the MT cohort compared to FS (HR 0.640; 95% CI 0.442–0.926; p = 0.018). Mortality was additionally reduced after the implementation of PS (p = 0.023). Combined operative success was comparable between the three access types. The perioperative success was higher in the MT cohort compared to FS (OR 2.19, 95% CI 1.32–3.63; p = 0.002). Conclusion: Less-invasive approaches in elderly patients improve perioperative success and reoperation-free survival in those undergoing MVS procedures.

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Seven Habits of Highly Effective Endoscopic Mitral Surgeons

Cited by 8 publications

References 17 publications

Minimally invasive tricuspid valve surgery

Minimally invasive tricuspid valve surgery

Adoption of minimally invasive mitral valve surgery in the NHS. A blend of science and psychology.

An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery

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