Robotic cardiac surgery. A marketing fuss or a real benefit?
Robotic surgery has been hitting the headlines for years. Notwithstanding, it is not widely understood what robotic surgery is really about and what are the benefits and pitfalls of this technology.
Nowadays, when we talk about robotic surgery we mean surgery performed with the da Vinci telemanipulator (Intuitive Surgical, Sunnyvale, CA, USA). It is not the sole robotic system available, but it is indeed the most advanced authority cleared surgical robot. It is successfully commercialized worldwide and dominates almost 100% of the market.
How to handle the ischemic mitral valve during CABG surgery
This post refers to two intriguing presentations of this year’s EACTS meeting, held in Vienna. Both presentations deal with the chronically ischemic mitral valve (graded at least moderate) as a concomitant finding in patients qualifying for coronary artery bypass grafting. The indication for revascularization is an important differentiator: chronic mitral regurgitation due to past myocardial infarction can also be an entity by itself (i.e. without the need for a revascularization procedure). This entity poses a delicate and difficult question on the best option of how to deal with it. Surgery does not always deliver the desired result, the newer interventional option of Mitraclip® is currently in evolving investigation. I will come back to this issue with a dedicated post. Stay tuned!
Our clinical situation:
- Angiographically confirmed ischemic heart disease (IHD) needing surgical revascularization
- Concomitant, at least moderate mitral valve regurgitation due to restricted leaflet motion (no prolapse – Carpentier class IIIB) and / or annular dilatation, called Ischemic Mitral Valve Regurgitation (IMVR)
The evolution of coronary artery bypass grafting: coronary surgery through small incisions (MICS-CABG).
The way to carry out an aortocoronary bypass has remained relatively unchanged during the last decades. The introduction of the beating heart surgery technique 10-15 years ago originated several technical and technological innovations, which made the procedure easier and safer. These developments created the potential for further approaches.
The latest evolution is performing the operation through a small incision under the left breast (mini-thoracotomy), also called MICS-CABG (minimally invasive cardiac surgery – coronary artery bypass grafting).