Totally Endoscopic Robot-Assisted Aortic Valve Replacement and Complex Mitral Valve Repair: The Lateral Approach

Wong, Daniella; Yost, Colin C.; Rosen, Jake L.; Wu, Meagan; Guy, T. Sloane

doi:10.1177/15569845221106939

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…5,6 Wong et al reported simultaneous surgery for AV replacement and MV repair via a lateral approach. 7 They stressed the importance of the lateral approach for the same reason that we shifted the camera port lateral and cranial to the standard position, which is used in our standard robotic MV surgery.…”

Section: Discussionmentioning

confidence: 99%

Robotic Surgery for Triple Valve Insufficiency: A Case Report

Ishikawa

Watanabe

Koakutsu

et al. 2023

Innovations�(Phila)

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A 63-year-old woman was referred to our institution for surgical treatment of triple valve (aortic, mitral, and tricuspid) insufficiency and underwent a robot-assisted endoscopic procedure. Three intercostal ports were placed in the right lateral chest for robotic instruments and a retrograde cardioplegic cannula, and a 5 cm thoracotomy was made for the procedure, which was a mitral valve repair with neochords and ring annuloplasty, an aortic valve replacement with bioprosthetic valve, and a ring tricuspid annuloplasty. Surgery was successfully achieved without blood transfusion or any complications.

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Section: Discussionmentioning

confidence: 99%

Robotic Surgery for Triple Valve Insufficiency: A Case Report

Ishikawa

Watanabe

Koakutsu

et al. 2023

Innovations�(Phila)

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“…Our methods for robotic port placement and percutaneous cannulation were previously described in detail. 10,11 We routinely preclose the vessels by using 2 sets of Perclose ProGlide percutaneous suture (Abbott Laboratories, Chicago, IL, USA) each at 2 and 10 o’clock positions on the vessel before giving heparin. Once protamine administration is completed, an 8 Fr Angio-Seal (Terumo Medical Corporation, Tokyo, Japan) is placed for additional hemostasis.…”

Section: Robotic Port Placement Peripheral Cannulation and Intraclude...mentioning

confidence: 99%

Endoaortic Balloon Occlusion in Totally Endoscopic and Percutaneous Robotic Cardiac Surgery

Kaneyuki

Yost

Round

et al. 2023

Innovations�(Phila)

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Previous studies have shown that the endoaortic balloon occlusion (EABO) can provide satisfactory aortic cross-clamping with comparable surgical outcomes to thoracic aortic clamping in the setting of minimally invasive and robotic cardiac surgery. We described our approach to EABO use in totally endoscopic and percutaneous robotic mitral valve surgery. Preoperative computed tomography angiography is required to evaluate the quality and size of the ascending aorta, identify access sites for peripheral cannulation and endoaortic balloon insertion, and screen for other vascular anomalies. Continuous bilateral upper extremity arterial pressure and cranial near-infrared spectroscopy monitoring are essential to detect obstruction of the innominate artery due to distal balloon migration. Transesophageal echocardiography is needed for continuous monitoring of balloon positioning and antegrade cardioplegia delivery. Direct fluorescent visualization of the endoaortic balloon on the robotic camera allows for verification of balloon and efficient repositioning if needed. The surgeon should assess hemodynamic and imaging information simultaneously during the balloon inflation and delivery of antegrade cardioplegia. Aortic root pressure, systemic blood pressure, and balloon catheter tension affect the position of the inflated endoaortic balloon in the ascending aorta. The surgeon should eliminate all slack in the balloon catheter and lock it into position to prevent proximal balloon migration after the completion of antegrade cardioplegia. Using scrupulous preoperative imaging assessment and continuous intraoperative monitoring, the EABO can achieve adequate cardiac arrest in totally endoscopic robotic cardiac surgery, even in patients with previous sternotomy without compromise of surgical outcomes.

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