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Dimitroglou Y, Karanasos A, Katsaros A, Kalompatsou A, Tsigkas G, Toutouzas K, Tsioufis C, Aggeli C, Davlouros P. Intraoperative Transesophageal Echocardiographic Guidance in Cardiac Surgery. J Cardiovasc Dev Dis 2025; 12:93. [PMID: 40137091 PMCID: PMC11943419 DOI: 10.3390/jcdd12030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 02/19/2025] [Accepted: 02/24/2025] [Indexed: 03/27/2025] Open
Abstract
Transesophageal echocardiography (TEE) is a valuable tool for diagnosing structural heart diseases, offering superior resolution compared to transthoracic echocardiography. It allows for real-time evaluation of cardiac valves and both systolic and diastolic heart function. Additionally, TEE facilitates the prompt detection of potential complications during cardiac surgeries, such as paravalvular leaks, iatrogenic aortic dissections, and pericardial effusions. Advances in imaging, including 3D echocardiography, have further enhanced the visualization of complex structures like cardiac valves, providing "surgical views" that improve preoperative planning. These features have also made TEE indispensable for postoperative evaluation of cardiac valve repairs and for intraoperative guidance during minimally invasive procedures. This review article aims to summarize the indications for using TEE as an intraoperative tool in cardiac surgery.
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Affiliation(s)
- Yannis Dimitroglou
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece; (Y.D.); (A.K.); (K.T.); (C.T.); (C.A.)
| | - Antonios Karanasos
- School of Medicine, Patras University Hospital, 26504 Patras, Greece; (G.T.); (P.D.)
| | - Andreas Katsaros
- Department of Cardiac Surgery, Hippokration Hospital, 11527 Athens, Greece;
| | - Argyro Kalompatsou
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece; (Y.D.); (A.K.); (K.T.); (C.T.); (C.A.)
| | - Grigorios Tsigkas
- School of Medicine, Patras University Hospital, 26504 Patras, Greece; (G.T.); (P.D.)
| | - Konstantinos Toutouzas
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece; (Y.D.); (A.K.); (K.T.); (C.T.); (C.A.)
| | - Costantinos Tsioufis
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece; (Y.D.); (A.K.); (K.T.); (C.T.); (C.A.)
| | - Constantina Aggeli
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece; (Y.D.); (A.K.); (K.T.); (C.T.); (C.A.)
| | - Periklis Davlouros
- School of Medicine, Patras University Hospital, 26504 Patras, Greece; (G.T.); (P.D.)
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Klotz SGR, Begerow A, Girdauskas E. Development of a core outcome set of quality indicators for enhanced recovery after surgery in minimally invasive cardiac heart valve surgery by interprofessional Delphi consensus. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 40:ivae218. [PMID: 39724277 PMCID: PMC11706534 DOI: 10.1093/icvts/ivae218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 12/13/2024] [Accepted: 12/24/2024] [Indexed: 12/28/2024]
Abstract
OBJECTIVES A core outcome set (COS) giving indicators of the quality of the process for minimally invasive valve surgery embedded into enhanced recovery after surgery (ERAS) protocols should be developed. METHODS Using web-based questionnaires, a Delphi process with three rounds was conducted from January to December 2022. Prior to the rounds, a systematic database search was performed identifying potential quality parameters. Experts for the panel were selected reflecting the interprofessional nature of the ERAS protocol. In the first round, participants could make suggestions of indicators in the pre-, intra- or postoperative and rehabilitative phase. These suggestions form together with the indicators of the literature a first indicator list. In the second round, participants could rate the relevance of the indicators resulting in a condensed indicator list. The third round was performed for further condensation based on importance ranking of the remaining indicators. RESULTS Three studies could be included in the systematic literature search providing a list of 22 indicators. Twenty-one experts participated in the Delphi survey. The experts named 315 indicators in the first round. After condensation in two further rounds, the final COS consisted of 24 indicators in the categories structure, process, outcome and complications. CONCLUSIONS A consensual minimum set of quality measurements during pre-, intra- and postoperative and rehabilitation phase for patients with minimally invasive heart surgery is now available for enhancing the quality of clinical practice and facilitating comparisons across different ERAS programs.
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Affiliation(s)
- Susanne G R Klotz
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anke Begerow
- Department of Patient and Care Management, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiothoracic Surgery, University Hospital Augsburg, Augsburg, Germany
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Staromłyński J, Kowalówka A, Gocoł R, Hudziak D, Żurawska M, Nowak W, Pasierski M, Sarnowski W, Smoczyński R, Bartczak M, Brączkowski J, Sadecka S, Drobiński D, Deja M, Szymański P, Suwalski P, Kowalewski M. Comparative Analysis of Long-Term Outcomes in Valve-Sparing Aortic Root Reimplantation: Full Sternotomy versus Mini-Sternotomy Approach. J Clin Med 2024; 13:2692. [PMID: 38731222 PMCID: PMC11084568 DOI: 10.3390/jcm13092692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively (p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter (p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality (p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome.
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Affiliation(s)
- Jakub Staromłyński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Adam Kowalówka
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Radosław Gocoł
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Małgorzata Żurawska
- Clinical Cardiology Department, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.Ż.); (P.S.)
| | - Wojciech Nowak
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Michał Pasierski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Wojciech Sarnowski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Radosław Smoczyński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Maciej Bartczak
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Jakub Brączkowski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Sabina Sadecka
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Dominik Drobiński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Marek Deja
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Szymański
- Clinical Cardiology Department, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.Ż.); (P.S.)
| | - Piotr Suwalski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Mariusz Kowalewski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 90127 Palermo, Italy
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Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D, Rodriguez Cetina Biefer H, Dzemali O. Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery. J Clin Med 2023; 12:7210. [PMID: 38068262 PMCID: PMC10707549 DOI: 10.3390/jcm12237210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 06/26/2024] Open
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.
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Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
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Zuo Y, Tan R, Qin C. Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis. J Cardiothorac Surg 2023; 18:206. [PMID: 37400892 DOI: 10.1186/s13019-023-02329-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). DESIGN Meta-analysis with meta-regression and systematic review. SETTING Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. INTERVENTIONS All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. RESULT Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. CONCLUSION The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.
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Affiliation(s)
- Yiding Zuo
- Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ruixi Tan
- Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chaoyi Qin
- Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, 610041, China.
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