Minimally Invasive Archives - The Baird Institute

Measurement of tremor transmission during microsurgery

March 29, 2016December 18, 2015 by Verrelli DI, Qian Y, Wood J, Wilson MK

Verrelli DI, Qian Y, Wood J, Wilson MK

Int J Med Robot 2015 Dec;

Abstract

BACKGROUND: Tremor is a major impediment to performing fine motor tasks, as in microsurgery. However, conventional measurements do not involve tasks representative of microsurgery.

METHOD: We developed a low-cost surgical simulator incorporating a force transducer capable of detecting and quantifying the effects of tremor upon high-fidelity silicone replicas of cardiac vessels and substrate muscle. Experienced and trainee surgeons performed simulated anastomoses on this rig. We characterized procedures in terms of tremor intensity, based on Lomb-Scargle periodograms.

RESULTS: Distinctive force oscillations occurred at 8-12 Hz, characteristic of enhanced physiological tremor, yielding peaks in power spectral density. These early results suggest a significantly lower transmission of tremor to the operative field by the experienced surgeon in comparison to the trainees.

CONCLUSIONS: This new device quantifies the action of tremor upon a manipulandum during a complex task, which may be used for assessment and providing feedback to trainee surgeons. Copyright © 2015 John Wiley & Sons, Ltd.

Geriatric cardiac surgery: chronology vs. biology

May 12, 2020September 22, 2014 by Seco M, Edelman JJ, Forrest P, Ng M, Wilson MK, Fraser J, Bannon PG, Vallely MP

Seco M, Edelman JJ, Forrest P, Ng M, Wilson MK, Fraser J, Bannon PG, Vallely MP

Heart Lung Circ 2014 Sep;23(9):794-801

PMID: 24851829

Abstract

Cardiac surgery is increasingly performed in elderly patients, and whilst the incidence of common risk factors associated with poorer outcome increases with age, recent studies suggest that outcomes in this population may be better than is widely appreciated. As such, in this review we have examined the current evidence for common cardiac surgical procedures in patients aged over 70 years. Coronary artery bypass grafting (CABG) in the elderly has similar early safety to percutaneous intervention, though repeat revascularisation is lower. Totally avoiding instrumentation of the ascending aorta with off-pump techniques may also reduce the incidence of neurological injury. Aortic valve replacement (AVR) significantly improves quality of life and provides excellent short- and long-term outcomes. Combined AVR and CABG carries higher risk but late survival is still excellent. Mini-sternotomy AVR in the elderly can provide comparable survival to full-sternotomy AVR. More accurate risk stratification systems are needed to appropriately select patients for transcatheter aortic valve implantation. Mitral valve repair is superior to replacement in the elderly, although choosing the most effective method is important for achieving maximal quality of life. Minimally-invasive mitral valve surgery in the elderly has similar postoperative outcomes to sternotomy-based surgery, but reduces hospital length of stay and return to activity. In operative candidates, surgical repair is superior to percutaneous repair. Current evidence indicates that advanced age alone is not a predictor of mortality or morbidity in cardiac surgery. Thus surgery should not be overlooked or denied to the elderly solely on the basis of their “chronological age”, without considering the patient’s true “biological age”.

Minimally invasive mitral valve surgery using single dose antegrade Custodiol cardioplegia

January 3, 2015September 22, 2014 by Matzelle SJ, Murphy MJ, Weightman WM, Gibbs NM, Edelman JJ, Passage J

Matzelle SJ, Murphy MJ, Weightman WM, Gibbs NM, Edelman JJ, Passage J

Heart Lung Circ 2014 Sep;23(9):863-8

PMID: 24767979

Abstract

OBJECTIVE: Our unit began a minimally invasive mitral surgery (MIMS) program utilising antegrade Custodiol solution as the sole cardioplegia. The aim of this paper is to report our results of this program.

PATIENTS/METHODS: Early clinical outcomes were identified and assessed for the first consecutive 100 MIMS patients with comparisons made to a historical group operated via a sternotomy (n=113). The efficacy of myocardial protection was assessed using surrogate outcomes of myocardial protection with serial sodium concentrations also analysed.

RESULTS: Six hours postoperatively 12 patients required inotropic support. Peak troponin-I in the first 24 hours was 5.1 (0.8-40 μg/L [median(range)]. Sodium levels decreased following administration of Custodiol but by six hours postoperatively the sodium had returned to greater than 130 mmol/L in all but five patients. Blood transfusion was smaller in the MIMS versus historical group (RBC 17% vs. 65%). MIMS patients had a shorter duration of ventilation, hospital stay and one-year mortality rate (0%).

CONCLUSIONS: In this series of patients undergoing MIMS, single dose antegrade Custodiol offers satisfactory and safe myocardial protection. Early clinical outcomes were also satisfactory. Whilst our findings are observational, they nevertheless support the use of this less invasive approach to mitral surgery using single dose Custodiol for myocardial protection.

A meta-analysis of endoscopic versus conventional open radial artery harvesting for coronary artery bypass graft surgery

January 3, 2015August 12, 2014 by Cao C, Tian DH, Ang SC, Peeceeyen S, Allan J, Fu B, Yan TD

Cao C, Tian DH, Ang SC, Peeceeyen S, Allan J, Fu B, Yan TD

Innovations (Phila) 2014 Jul-Aug;9(4):269-75

PMID: 25084252

Abstract

OBJECTIVE: The radial artery has been demonstrated to provide superior long-term patency outcomes compared with saphenous veins for selected patients who undergo coronary artery bypass graft surgery. Recently, endoscopic radial artery harvesting has been popularized to improve cosmetic and perioperative outcomes. However, concerns have been raised regarding the effects on long-term survival and graft patency of this relatively novel technique. The present meta-analysis aimed to assess the safety and the efficacy of endoscopic radial artery harvesting versus the conventional open approach.

METHODS: A systematic review of the current literature was performed on five electronic databases. All comparative studies on endoscopic versus open radial artery harvesting were included for analysis. Primary endpoints included mortality and recurrent myocardial infarction. Secondary endpoints included graft patency, wound infection, hematoma formation, and paresthesia.

RESULTS: Twelve studies involving 3314 patients were included for meta-analysis according to predefined selection criteria. There were no statistically significant differences in overall mortality, recurrent myocardial infarction, or graft patency between the two surgical techniques. However, patients who underwent endoscopic harvesting were found to have significantly lower incidences of wound infection, hematoma formation, and paresthesia.

CONCLUSIONS: Current literature on endoscopic harvesting of the radial artery for coronary artery bypass graft surgery is limited by relatively short follow-up periods as well as differences in patient selection and surgical techniques. In addition, there are currently no randomized controlled trials to provide robust clinical data. However, the available evidence suggests that the endoscopic approach is associated with superior perioperative outcomes without clear evidence demonstrating compromised patency or survival outcomes.

Transapical aortic valve implantation – an Australian experience

January 3, 2015May 12, 2014 by Seco M, Martinez G, Bannon PG, Cartwright BL, Adams M, Ng M, Wilson MK, Vallely MP

Seco M, Martinez G, Bannon PG, Cartwright BL, Adams M, Ng M, Wilson MK, Vallely MP

Heart Lung Circ 2014 May;23(5):462-8

PMID: 24315653

Abstract

BACKGROUND: The aim of this study was to report our initial experience with the transapical approach to transcatheter aortic valve implantation (TAVI) at an Australian institution.

METHODS: All patients with severe, symptomatic aortic stenosis were assessed by our multidisciplinary team. A total of 32 patients received a transapical TAVI using an Edwards SAPIEN prosthesis. Data were prospectively collected and analysed according to the Valve Academic Research Consortium version 2 guidelines.

RESULTS: Intraoperative outcomes included: 100% device success with no conversion to surgical valve replacement, extracorporeal membrane oxygenation was used electively in 15.6% and emergently in 6.3%, and no valve migration or malpositioning requiring prosthesis retrieval and re-implantation. Outcomes at 30 days post-TAVI included: No mortality, 3.1% myocardial infarction, no disabling stroke, 3.1% non-disabling stroke, no transient ischaemic attacks, 6.3% life-threatening bleeding, 15.6% major bleeding, 3.1% major vascular complications, and 12.5% postoperative acute kidney injury requiring renal replacement therapy. Mild paravalvular regurgitation was present in 29%, and there was no moderate or severe regurgitation. Mean follow-up time was 28.8±12.9 months. Cumulative results included: 9.4% mortality, 6.3% stroke, 6.3% myocardial infarction, and no repeat procedures. At one year postoperation, echocardiography demonstrated that the mean pressure across the prosthesis was 10.1±1.7mmHg, and the mean aortic valve area was 1.4±0.2cm(2).

CONCLUSION: Good short-term outcomes and low or zero mortality are achievable with transapical TAVI at an Australian institution.

A meta-analysis of MitraClip system versus surgery for treatment of severe mitral regurgitation

January 3, 2015December 18, 2013 by Wan B, Rahnavardi M, Tian DH, Phan K, Munkholm-Larsen S, Bannon PG, Yan TD

Wan B, Rahnavardi M, Tian DH, Phan K, Munkholm-Larsen S, Bannon PG, Yan TD

Ann Cardiothorac Surg 2013 Nov;2(6):683-92

PMID: 24349969

Abstract

BACKGROUND: Mitral regurgitation (MR) is the second most common valvular heart disease after aortic stenosis. Without intervention, prognosis is poor in patients with severe symptomatic MR. While surgical repair is recommended for many patients with severe degenerative MR (DMR), as many as 49% of patients do not qualify as they are at high surgical risk. Furthermore, surgical correction for functional MR (FMR) is controversial with suboptimal outcomes and significant perioperative mortality. The percutaneous MitraClip implantation can be seen as a viable option in high surgical risk patients. The purpose of this meta-analysis is to compare the safety, clinical efficacy, and survival outcomes of MitraClip implantation with surgical correction of severe MR.

METHODS: Six electronic databases were searched for original published studies from January 2000 to August 2013. Two reviewers independently appraised studies, using a standard form, and extracted data on methodology, quality criteria, and outcome measures. All data were extracted and tabulated from the relevant articles’ texts, tables, and figures and checked by another reviewer.

RESULTS: Overall 435 publications were identified. After applying selection criteria and removing serial publications with accumulating number of patients or increased length of follow-up, four publications with the most complete dataset were included for quality appraisal and data extraction. There was one randomized controlled trial (RCT) and three prospective observational studies. At baseline, patients in the MitraClip group were significantly older (P=0.01), had significantly lower LVEF (P=0.03) and significantly higher EuroSCORE (P2 was significantly higher in the MitraClip group compared to the surgical group (17.2% vs. 0.4%; P<0.0001). 30-day mortality was not statistically significant (1.7% vs. 3.5%; P=0.54), nor were neurological events (0.85% vs. 1.74%; P=0.43), reoperations for failed MV procedures (2% vs. 1%; P=0.56), NYHA Class III/IV (5.7% vs. 11.3; P=0.42) and mortality at 12 months (7.4% vs. 7.3%; P=0.66).

CONCLUSIONS: Despite a higher risk profile in the MitraClip patients compared to surgical intervention, the clinical outcomes were similar although surgery was more effective in reducing MR in the early post procedure period. We conclude the non-inferiority of the MitraClip as a treatment option for severe, symptomatic MR in comparison to conventional valvular surgery.

Systematic review of robotic minimally invasive mitral valve surgery

January 3, 2015December 18, 2013 by Seco M, Cao C, Modi P, Bannon PG, Wilson MK, Vallely MP, Phan K, Misfeld M, Mohr F, Yan TD

Seco M, Cao C, Modi P, Bannon PG, Wilson MK, Vallely MP, Phan K, Misfeld M, Mohr F, Yan TD

Ann Cardiothorac Surg 2013 Nov;2(6):704-16

PMID: 24349971

Abstract

BACKGROUND: Robotic telemanipulators have evolved to assist the challenges of minimally invasive mitral valve surgery (MVS). A systematic review was performed to provide a synopsis of the literature, focusing on clinical outcomes and cost-effectiveness.

METHOD: Structured searches of MEDLINE, Embase, and Cochrane databases were performed in August 2013. All original studies except case-reports were included in qualitative review. Studies with ≥50 patients were presented quantitatively.

RESULTS: After applying inclusion and exclusion criteria to the search results, 27 studies were included in qualitative review, 16 of which had ≥50 patients. All studies were observational in nature, and thus the quality of evidence was rated low to medium. Patients generally had good left ventricular performance, were relatively asymptomatic, and mean patient age ranged from 52.6-58.4 years. Rates of intraoperative outcomes ranged from: 0.0-9.1% for conversion to non-robotic surgery, 106±22 to 188.5±53.8 min for cardiopulmonary bypass (CPB) time and 79±16 to 140±40 min for cross-clamp (XC) time. Rates of short-term postoperative outcomes ranged from: 0.0-3.0% for mortality, 0.0-3.2% for myocardial infarction (MI), 0.0-3.0% for permanent stroke, 1.6-15% for pleural effusion, 0.0-5.0% for reoperations for bleeding, 0.0-0.3% for infection, and 1.1-6% for prolonged ventilation (>48 hours), 1.5-5.4% for early repair failure, 12.3±6.7 to 36.6±24.7 hours for intensive care length of stay, 3.1±0.3 to 6.3±3.9 days for hospital length of stay (HLOS) and 81.7-97.6% had no or trivial mitral regurgitation (MR) before discharge.

CONCLUSIONS: All subtypes of mitral valve prolapse are repairable with robotic techniques. CPB and XC times are long, and novel techniques such as the Cor-Knot, Nitinol clips or running sutures may reduce the time required. The overall rates of early postoperative mortality and morbidity are low. Improvements in postoperative quality of life (QoL) and expeditious return to work offset the increase in equipment and intraoperative cost. Evidence for long-term outcomes is as yet limited.

Custodiol for myocardial protection and preservation: a systematic review

January 3, 2015December 18, 2013 by Edelman JJ, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, Yan TD, Wilson MK, Bannon PG, Vallely MP, Passage J

Edelman JJ, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, Yan TD, Wilson MK, Bannon PG, Vallely MP, Passage J

Ann Cardiothorac Surg 2013 Nov;2(6):717-28

PMID: 24349972

Abstract

INTRODUCTION: Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant.

METHODS: Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant.

RESULTS: Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant.

CONCLUSIONS: Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required.

Measurement of tremor transmission during microsurgery

Abstract

Geriatric cardiac surgery: chronology vs. biology

Abstract

Minimally invasive mitral valve surgery using single dose antegrade Custodiol cardioplegia

Abstract

A meta-analysis of endoscopic versus conventional open radial artery harvesting for coronary artery bypass graft surgery

Abstract

Transapical aortic valve implantation – an Australian experience

Abstract

A meta-analysis of MitraClip system versus surgery for treatment of severe mitral regurgitation

Abstract

Systematic review of robotic minimally invasive mitral valve surgery

Abstract

Custodiol for myocardial protection and preservation: a systematic review

Abstract

Our Mission

Donate by Phone

About Us

Resources

You Can Help

Stay in the loop

Honour a Loved One

Challenge Yourself

Organise a community event

Seek sponsorship to help you quit those bad habits

Celebrate Through Giving

Minimally Invasive

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Our Mission

Donate by Phone

About Us

Resources

You Can Help

Stay in the loop

Honour a Loved One

Challenge Yourself

Organise a community event

Seek sponsorship to help you quit those bad habits

Celebrate Through Giving

Create a CrowdRaiser on GiveNow

Start a Facebook Fundraiser