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The Future of Open Heart Surgery in the Era of Robotic and Minimal Surgical Interventions.

机器人和最小手术干预时代心脏直视手术的未来。

  • 影响因子:1.64
  • DOI:10.1016/j.hlc.2019.05.170
  • 作者列表:"Harky A","Chaplin G","Chan JSK","Eriksen P","MacCarthy-Ofosu B","Theologou T","Muir AD
  • 发表时间:2020-01-01
Abstract

:It has been over two decades since the very first robotic cardiac surgery was performed. Over the years, there has been an increase in the demand for less invasive cardiac surgical techniques. Developments in technology and engineering have provided an opportunity for robotic surgery to be applied to a variety of cardiac procedures, including coronary revascularisation, mitral valve surgery, atrial fibrillation ablation, and others. In coronary revascularisation, it is becoming more widely used in single vessel, as well as hybrid coronary artery approaches. Currently, several international centres are specialising in a totally endoscopic coronary artery bypass surgery involving multiple vessels. Mitral valve and other intracardiac pathologies such as atrial septal defect and intracardiac tumour are also increasingly being addressed robotically. Even though some studies have shown good results with robot-assisted cardiac surgery, there are still concerns about safety, cost and clinical efficacy. There are also limitations and additional challenges with the management of cardiopulmonary bypass and myocardial protection during robotic surgery. Implementing novel strategies to manage these challenges, together with careful patient selection can go a long way to producing satisfactory results. This review examines the current evidence behind robotic surgery in various aspects of cardiac surgery.

摘要

: 自从第一例机器人心脏手术实施以来,已经超过 20 年了。多年来,对微创心脏外科技术的需求不断增加。技术和工程的发展为机器人手术应用于各种心脏手术提供了机会,包括冠状动脉血运重建、二尖瓣手术、房颤消融等。在冠状动脉血运重建中,它越来越广泛地用于单支血管以及混合冠状动脉方法。目前,几个国际中心专门从事涉及多血管的完全内窥镜冠状动脉搭桥手术。二尖瓣和其他心内病变如房间隔缺损和心内肿瘤也越来越多地被机器人解决。尽管一些研究显示了机器人辅助心脏手术的良好效果,但仍存在安全性、成本和临床疗效的担忧。在机器人手术过程中,体外循环和心肌保护的管理也存在局限性和额外的挑战。实施新的策略来管理这些挑战,加上仔细的患者选择,可以大大提高产生令人满意的结果。这篇综述检查了机器人手术在心脏手术各个方面背后的当前证据。

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METHODS:BACKGROUND AND PURPOSE:The current left atrial appendage (LAA) classification system (cLAA-CS) categorizes it into 4 morphologies: chicken wing (CW), windsock, cactus, and cauliflower, though there is limited data on either reliability or associations between different morphologies and stroke risk. We aimed to develop a simplified LAA classification system and to determine its relationship to embolic stroke subtypes. METHODS:Consecutive patients with ischemic stroke from a prospective stroke registry who previously underwent a clinically-indicated chest CT were included. Stroke subtype was determined and LAA morphology was classified using the traditional system (in which CW = low risk) and a new system (LAA-H/L, in which low risk morphology (LAA-L) was defined as an acute angle bend or fold from the proximal/middle portion of the LAA and high risk morphology (LAA-H) was defined as all others). As a proof of concept study, we determined reliability for the two classification systems, and we assessed the associations between both classification systems with stroke subtypes in our cohort and previous studies. RESULTS:We identified 329 ischemic stroke patients with a qualifying chest CT (126 cardioembolic subtype, 116 embolic stroke of undetermined source (ESUS), and 87 non-cardioembolic subtypes). Intra- and inter-rater agreements improved using the LAA-H/L (0.95 and 0.85, respectively) vs. cLAA-CS (0.50 and 0.40). The LAA-H/L led to classifying 69 LAA morphologies that met criteria for CW as LAA-H. In fully adjusted models, LAA-H was associated with cardioembolic stroke (OR 5.4, 95%CI 2.1-13.7) and ESUS (OR 2.8 95% CI 1.2-6.4). Non-CW morphology was also associated with embolic stroke subtypes, but the effect size was much less pronounced. Studies using the cLAA-CS yielded mixed results for inter- and intra-rater agreements but most showed an association between a non-CW morphology and stroke with no difference among the three non-CW subtypes. CONCLUSION:The LAA-H/L classification system is simple, has excellent intra and inter-rater agreements, and may help risk identify patients with cardioembolic stroke subtypes. Larger studies are needed to validate these findings.

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翻译标题与摘要 下载文献
影响因子:1.64
发表时间:2020-01-01
DOI:10.1016/j.hlc.2019.05.170
作者列表:["Harky A","Chaplin G","Chan JSK","Eriksen P","MacCarthy-Ofosu B","Theologou T","Muir AD"]

METHODS::It has been over two decades since the very first robotic cardiac surgery was performed. Over the years, there has been an increase in the demand for less invasive cardiac surgical techniques. Developments in technology and engineering have provided an opportunity for robotic surgery to be applied to a variety of cardiac procedures, including coronary revascularisation, mitral valve surgery, atrial fibrillation ablation, and others. In coronary revascularisation, it is becoming more widely used in single vessel, as well as hybrid coronary artery approaches. Currently, several international centres are specialising in a totally endoscopic coronary artery bypass surgery involving multiple vessels. Mitral valve and other intracardiac pathologies such as atrial septal defect and intracardiac tumour are also increasingly being addressed robotically. Even though some studies have shown good results with robot-assisted cardiac surgery, there are still concerns about safety, cost and clinical efficacy. There are also limitations and additional challenges with the management of cardiopulmonary bypass and myocardial protection during robotic surgery. Implementing novel strategies to manage these challenges, together with careful patient selection can go a long way to producing satisfactory results. This review examines the current evidence behind robotic surgery in various aspects of cardiac surgery.

翻译标题与摘要 下载文献
心律失常方向

心律失常(arrhythmia)是由于窦房结激动异常或激动产生于窦房结以外,激动的传导缓慢、阻滞或经异常通道传导,即心脏活动的起源和(或)传导障碍导致心脏搏动的频率和(或)节律异常。心律失常是心血管疾病中重要的一组疾病,可单独发病,亦可与其他心血管病伴发。其预后与心律失常的病因、诱因、演变趋势、是否导致严重血流动力障碍有关,可突然发作而致猝死,亦可持续累及心脏而致其衰竭。

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