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Abazid R, Romsa J, Akincioglu C, Warrington J, Bureau Y, Kiaii B, Vezina W. Coronary Artery Calcium Progression After Coronary Artery Bypass Graft Surgery. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alboom M, Browne A, Dagenais F, Noiseux N, Kieser T, Légaré J, Brown C, Kiaii B, Eikelboom J, Lamy A. PICK YOUR CONDUIT WISELY TO DECREASE GRAFT FAILURE AFTER CABG SURGERY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Sullivan R, Randhawa V, Stokes A, Liu S, Wu D, Charron C, Lalonde T, Luyt L, Kiaii B, Wisenberg G, Dhanvantari S. EXPRESSION OF THE GROWTH HORMONE SECRETAGOGUE RECEPTOR AND GHRELIN IN HUMAN HEART FAILURE. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Al-Amodi H, Pena D, Aluthman U, Allen P, Chu M, Kiaii B. EARLY EXPERIENCE WITH DEL NIDO CARDIOPLEGIA IN MINIMALLY INVASIVE CARDIAC SURGERY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Al-Amodi H, Teefy P, Diamantouros P, Bagur R, Chu M, Kiaii B. FIRST NORTH AMERICAN EXPERIENCE WITH THE SYMETIS TRANSCATHETER AORTIC BIOPROSTHESES FOR THE TREATMENT OF SEVERE AORTIC STENOSIS WITH 1-YEAR FOLLOW UP. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Swinamer S, Fox S, Nagpal D, Chu M, Quantz M, Guo R, Novick R, Kiaii B, Sy J, Gelinas J. ENDOSCOPIC RADIAL ARTERY HARVEST--OUTCOMES AND LESSONS LEARNED AFTER 1000 HARVESTS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Losenno K, Peterson M, Ouzounian M, Whitlock R, Dagenais F, Boodhwani M, Bhatnagar G, Poostizadeh A, Pozeg Z, Moon M, Kiaii B, Chu M. EARLY CLINICAL OUTCOMES OF A NOVEL FROZEN ELEPHANT TRUNK PROSTHESIS: THE CANADIAN THORACIC AORTIC COLLABORATIVE EXPERIENCE. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ginty O, Moore J, Xia W, Bainbridge D, Peters T, Kiaii B, Chu M. DYNAMIC PATIENT-SPECIFIC MITRAL VALVE MODELS FOR SURGERY SIMULATION. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chu M, Bagur R, Diamantouros P, Teefy P, Kiaii B. EARLY CLINICAL OUTCOMES WITH A NOVEL SELF-EXPANDING AORTIC BIOPROSTHESIS IN PATIENTS AT HIGHER RISK FOR CORONARY OBSTRUCTION: FIRST NORTH AMERICAN EXPERIENCE WITH THE ACURATE-TA SYSTEM. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bagur R, Teefy P, Kiaii B, Diamantouros P, Chu M. TRANSFEMORAL ACURATE-NEOTM SELF-EXPANDING TRANSCATHETER AORTIC VALVE IMPLANTATION: FIRST NORTH AMERICAN EXPERIENCE. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Alghofaili S, Bagur R, Diamantouros P, Kiaii B, Chu M, Teefy P. PREPARATORY BALLOON AORTIC VALVULOPLASTY DOES NOT INFLUENCE THE EVOLUTION OF PARAVALVULAR LEAK AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Randhawa V, Singal R, Freed D, Quantz M, Kiaii B, Nagpal A. IMPROVED EARLY MOBILIZATION WITH AXILLARY IMPLANT OF THE IMPELLA DEVICE: INSIGHTS FROM A DUAL CENTER CANADIAN EXPERIENCE. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gelinas J, Peterson M, Losenno K, Harrington A, Tam D, Fox S, Dickson J, Kiaii B, Chu M. PROPHYLACTIC SYNTHETIC SEALANT ADMINISTRATION SIGNIFICANTLY REDUCES THE NEED FOR BLOOD TRANSFUSIONS IN MAJOR AORTIC SURGERY. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chu M, Kiaii B, Teefy P, Diamantouros P, Bagur R. FIRST NORTH AMERICAN EXPERIENCE WITH THE ENGAGER SELF-EXPANDING TRANSCATHETER AORTIC VALVE: INSIGHTS FROM THE LONDON HEALTH SCIENCE CENTRE HEART TEAM. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hussain S, Adams C, Cleland A, Jones PM, Walsh G, Kiaii B. Lessons from aviation - the role of checklists in minimally invasive cardiac surgery. Perfusion 2015; 31:68-71. [DOI: 10.1177/0267659115584785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe an adverse event during minimally invasive cardiac surgery that resulted in a multi-disciplinary review of intra-operative errors and the creation of a procedural checklist. This checklist aims to prevent errors of omission and communication failures that result in increased morbidity and mortality. We discuss the application of the aviation - led “threats and errors model” to medical practice and the role of checklists and other strategies aimed at reducing medical errors.
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Affiliation(s)
- S Hussain
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - C Adams
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - A Cleland
- Division of Clinical Perfusion Services, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - PM Jones
- Department of Anesthesia & Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - G Walsh
- Division of Clinical Perfusion Services, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - B Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
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German M, Minuk L, Adams C, Diamantouros P, Iglesias I, Jones PM, Kiaii B. Robotic coronary artery bypass surgery in a patient with haemophilia A. Haemophilia 2014; 21:e128-e130. [DOI: 10.1111/hae.12594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/01/2022]
Affiliation(s)
- M. German
- Division of Cardiac Surgery Department of Surgery London Health Sciences Centre Western University London Ontario Canada
| | - L. Minuk
- Division of Hematology London Health Sciences Centre Western University London Ontario Canada
| | - C. Adams
- Division of Cardiac Surgery Department of Surgery London Health Sciences Centre Western University London Ontario Canada
| | - P. Diamantouros
- Division of Cardiology Department of Medicine London Health Sciences Centre Western University London Ontario Canada
| | - I. Iglesias
- Department of Anesthesia and Perioperative Medicine London Health Sciences Centre Western University London Ontario Canada
| | - P. M Jones
- Department of Anesthesia and Perioperative Medicine London Health Sciences Centre Western University London Ontario Canada
| | - B. Kiaii
- Division of Cardiac Surgery Department of Surgery London Health Sciences Centre Western University London Ontario Canada
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Catrip J, AlHabib H, Chu M, Swinamer S, Rayman R, Kiaii B. IMMEDIATE CLINICAL OUTCOME OF ROBOTIC ASSISTED CABG IN PATIENTS WITH PREVIOUS HEART SURGERY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Fernandes P, Cleland A, Bainbridge D, Jones PM, Chu MWA, Kiaii B. Development of our TAVI protocol for emergency initiation of cardiopulmonary bypass. Perfusion 2014; 30:34-9. [PMID: 25143415 DOI: 10.1177/0267659114547754] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
All transcatheter aortic valve implantation (TAVI) cases are done in our hybrid operating room with a multidisciplinary team and a primed cardiopulmonary bypass (CPB) circuit on pump stand-by. We decided that we would resuscitate all patients undergoing a TAVI procedure via a transfemoral, transapical or transaortic approach, if required. Perfusion plays an essential role in providing rescue CPB for patient salvage when catastrophic complications occur. To coordinate the multidisciplinary effort, we have developed a written safety checklist that assigns a pre-determined role for team members for the rapid sequence initiation of CPB. Although many TAVI patients are not candidates for conventional aortic valve replacements, we feel strongly that rescue CPB should be offered to all TAVI patients to allow the correction of potentially reversible complications. This protocol is included in every surgical "Time Out" involving a TAVI procedure (Figure 1). The protocol has led to rapid and safe CPB initiation in less than five minutes of cardiac arrest. It has also led to a coordinated and consistent team, with pre-specified roles and improved communication. We discuss a case series of four TAVI patients who required emergent use of CPB. The first few cases did not have a written protocol. The experience from these cases led to the development of our protocol. We identified a lack of coordination, wasted movements, unnecessary delayed resuscitation and overall chaos, each of which was targeted for correction with the protocol. We will discuss the merits of the protocol in two recent TAVI cases which required emergent CPB.
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Affiliation(s)
- P Fernandes
- Clinical Perfusion Services, Cardiac Care, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada, Western University, Lawson Health Research, Canada
| | - A Cleland
- Clinical Perfusion Services, Cardiac Care, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada, Western University, Lawson Health Research, Canada
| | - D Bainbridge
- Department of Anesthesia and Perioperative Medicine, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada, Western University, Lawson Health Research, Canada
| | - P M Jones
- Department of Anesthesia and Perioperative Medicine, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada, Western University, Lawson Health Research, Canada
| | - M W A Chu
- Clinical Perfusion Services, Cardiac Care, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada, Western University, Lawson Health Research, Canada
| | - B Kiaii
- Clinical Perfusion Services, Cardiac Care, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada, Western University, Lawson Health Research, Canada
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Kiaii B, Seijts G, Patel R, Ward C, Cherry R, Woodwark M. Inclusive Team Training for Cardiac Surgery: Combining Multiple Simulators. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kiaii B, Stephanie F, Swinamer S, Rayman R, Dobkowski W, Iglesias I, Bainbridge D, Harle C, Murkin J, Chu M, Boyd D, Menkis A. 14 Year Experience With Robotic Assisted Surgical Coronary Artery Revascularization With Postoperative Cardiac Catheterization. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chu M, Bainbridge D, Cleland A, Murkin J, Kiaii B. Percutaneous Superior Vena Cava Drainage Improves Outcomes During Minimally Invasive Mitral Valve Surgery: a Randomized, Cross-Over Study. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Al-Amodi H, Alhabib H, Adams C, Guo L, Kiaii B. Early Canadian Experience With the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass in Inoperable Patients With Severe Aortic Stenosis. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Losenno K, Fox S, Kiaii B, Chu M. Improved Outcomes of Re-Operative Mitral Valve Surgery Via Endoscopic, Right Mini-thoracotomy. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chu M, Losenno K, Adams C, Kiaii B. Pre-Operative Echocardiographic Method to Accurately Determine the Length of Neochordae Reconstruction for Mitral Valve Repair. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Moore JT, Chu MWA, Kiaii B, Bainbridge D, Guiraudon G, Wedlake C, Currie M, Rajchl M, Patel RV, Peters TM. A Navigation Platform for Guidance of Beating Heart Transapical Mitral Valve Repair. IEEE Trans Biomed Eng 2013; 60:1034-40. [DOI: 10.1109/tbme.2012.2222405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Azimian H, Patel RV, Naish MD, Kiaii B. A semi-infinite programming approach to preoperative planning of robotic cardiac surgery under geometric uncertainty. IEEE J Biomed Health Inform 2012; 17:172-82. [PMID: 23033329 DOI: 10.1109/titb.2012.2220557] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this paper, a computational framework for patient-specific preoperative planning of Robotics-Assisted Minimally Invasive Cardiac Surgery (RAMICS) is presented. It is expected that preoperative planning of RAMICS will improve the success rate by considering robot kinematics, patient-specific thoracic anatomy, and procedure-specific intraoperative conditions. Given the significant anatomical features localized in the preoperative computed tomography images of a patients thorax, port locations and robot orientations (with respect to the patients body coordinate frame) are determined to optimize qualities such as dexterity, reachability, tool approach angles and maneuverability. To address intraoperative geometric uncertainty, the problem is formulated as a Generalized Semi-Infinite Program (GSIP) with a convex lower-level problem to seek a plan that is less sensitive to geometric uncertainty in the neighborhood of surgical targets. It is demonstrated that with a proper formulation of the problem, the GSIP can be replaced by a tractable constrained nonlinear program that uses a multi-criteria objective function to balance between the nominal task performance and robustness to collisions and joint limit violations. Finally, performance of the proposed formulation is demonstrated by a comparison between the plans generated by the algorithm and those recommended by an experienced surgeon for several case studies.
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Swinamer S, Fox S, Chu M, Novick R, Quantz M, Myers M, Guo R, McKenzie N, Sy J, Kiaii B. 257 Eight Year Experience With Endoscopic Radial Artery Harvest At A Canadian Centre. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Currie M, Trejos A, Rayman R, Chu M, Patel R, Peters T, Kiaii B. 608 Measurement of forces applied by the davinci robot during ex vivo robotics-assisted porcine mitral valve annuloplasty. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Introduction: The purpose of the study is to clinically evaluate minimally invasive mitral valve surgeries (MIMVS) using a mini bypass circuit. The challenge to perfusion is to keep pace with MIMVS, with demonstrated improvements in perfusion-related technologies. Methods: From October 28, 2005 to September 10, 2008, we retrospectively evaluated thirty-four elective cases which used the mini-circuit (Medtronic Resting Heart System®), with respect to safety, efficacy, cannulation technique, blood usage, resultant hemoglobin, length of ICU and hospital stay, and complications. Conclusion: The Medtronic Resting Heart System® alleviates many factors, such as high shear stress, turbulence, air to blood interface and decreased oncotic pressure caused by hemodilution, providing more efficient perfusion to our MIMVS patients. We demonstrate, with minor circuit modifications and attention to venous air issues, that this mini-circuit can be used safely and effectively, while being associated with improvements in patient outcomes.
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Affiliation(s)
- P. Fernandes
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada,
| | - J. MacDonald
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - A. Cleland
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - R. Mayer
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - S. Fox
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - B. Kiaii
- London Health Sciences Centre, Clinical Perfusion Services, Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
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Trejos AL, Patel RV, Ross I, Kiaii B. Optimizing port placement for robot-assisted minimally invasive cardiac surgery. Int J Med Robot 2008; 3:355-64. [DOI: 10.1002/rcs.158] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Nagpal AD, Bhatnagar G, Cutrara CA, Ahmed SM, McKenzie N, Quantz M, Kiaii B, Menkis A, Fox S, Stitt L, Novick RJ. Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians. Can J Cardiol 2006; 22:849-53. [PMID: 16957802 PMCID: PMC2569020 DOI: 10.1016/s0828-282x(06)70303-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Off-pump coronary artery bypass (OPCAB) surgery has been successfully used in diverse patient populations and has been postulated to be safer than conventional coronary artery bypass (CCAB) surgery in some high-risk patients, including the elderly. OBJECTIVE To compare the safety of OPCAB surgery versus CCAB surgery in the octogenarian population of two large southwestern Ontario cardiac surgical units. RESULTS Two hundred thirty-six consecutive octogenarians underwent primary isolated coronary artery bypass surgery from November 2000 to March 2005. Patients undergoing OPCAB surgery tended to have higher Parsonnet scores, while patients undergoing CCAB surgery had a greater number of emergent operations. The Canadian Cardiovascular Network predicted that mortality risk was similar in both groups. In-hospital mortality was similar between groups, as was postoperative myocardial infarction and new onset of renal dysfunction. However, in the OPCAB group, there was a decreased incidence of postoperative neurological dysfunction (2.3% in the OPCAB group versus 10.5% in the CCAB group, P=0.01), in particular cerebrovascular accidents (1.5% in the OPCAB group versus 7.6% in the CCAB group, P=0.05), and a decreased incidence of prolonged intubation (5.3% in the OPCAB group versus 13.3% in the CCAB group, P=0.04). Multivariable analysis found that cardiopulmonary bypass had no significant impact on mortality or length of stay. CONCLUSIONS In octogenarian patients, OPCAB surgery is as safe as CCAB surgery in terms of mortality and major morbidity. Furthermore, a significant reduction in neurological dysfunction and prolonged intubation was seen in the OPCAB group compared with the CCAB group.
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Affiliation(s)
- A D Nagpal
- Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario.
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Kiaii B, Boyd WD, Rayman R, Dobkowski WB, Ganapathy S, Jablonsky G, Novick RJ. Robot-assisted computer enhanced closed-chest coronary surgery: preliminary experience using a Harmonic Scalpel and ZEUS. Heart Surg Forum 2006; 3:194-7. [PMID: 11074972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Successful endoscopic harvesting of arterial conduits is critical to the performance of totally endoscopic bypass grafting. Recent success with computer-enhanced robotic systems in the performance of endoscopic single vessel coronary artery bypass (ENDOCAB) has paved the way for developing techniques for multivessel ENDOCAB. The Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) has previously demonstrated versatility and efficacy in manual endoscopic internal thoracic artery (ITA) harvesting. This study was undertaken to determine the feasibility of adapting this technology to a robotic telemanipulation system and its safety and efficacy in telerobotic ITA harvesting. METHODS The Harmonic Scalpel was adapted to the ZEUS robotic surgical system (Computer Motion, Goleta, CA) and used to harvest the ITA in 19 patients undergoing multivessel off-pump coronary artery bypass (OPCAB) surgery. With the left lung collapsed, the ITA was harvested in all patients with CO2 insufflation through three 5 mm ports in the left chest. Postoperative angiography and transthoracic Doppler studies were performed in all patients. RESULTS There were no ITA injuries and patients tolerated insufflation without hemodynamic compromise. Side branches were controlled easily without bleeding. Average ITA harvest time was 65 +/- 21 minutes. All vessels were patent after harvesting and demonstrated no angiographic evidence of injury. CONCLUSIONS This paper demonstrates a technique by which the Harmonic Scalpel can be readily adapted to the ZEUS robotic telemanipulation system. Using this system, ITA's can be safely harvested totally endoscopically within a reasonable time frame for patients undergoing ENDOCAB.
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Affiliation(s)
- B Kiaii
- London Health Sciences Centre, London, Ontario, Canada
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Doll N, Kornherr P, Aupperle H, Fabricius AM, Kiaii B, Ullmann C, Schneider K, Dhein S, Schoon HA, Rastan A, Walther T, Mohr FW. Epicardial Treatment of Atrial Fibrillation Using Cryoablation in an Acute Off-pump Sheep Model. Thorac Cardiovasc Surg 2003; 51:267-73. [PMID: 14571343 DOI: 10.1055/s-2003-43086] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to test the feasibility and effectiveness of cryoablation therapy (SurgiFrost trade mark CryoCath, Endocare Inc., Irvine, California, USA) for linear epicardial treatment of atrial fibrillation in an acute off-pump sheep model. METHODS After thoracotomy, we performed epicardial cryoablation (2 min intervals at -160 degrees C) with pacing electrodes positioned at the left atrial appendage (LAA), the pulmonary veins (PVs), the right atrial appendage (RAA), and the vena cava cranialis (VCC) in 8 sheep. Circular epicardial ablations were performed with online temperature measurement in the ascending aorta and in the esophagus. The sheep were sacrificed two hours after ablation procedure, and heart, lungs, and esophagus were retrieved for histological examination. Out of all 8 sheep, histo-pathological analysis was performed on the RAA and VCC in 6 sheep and on the CAA and PV in all 8 sheep. RESULTS Thin-walled structures such as PVs and VCC showed electrical isolation. No significant changes in temperature in the descending aorta and the esophagus were observed. There was evidence of extensive transmural alteration including vascular lesions, myocardial degeneration and necrosis as well as epi- and endocardial necrosis in the left atria in three of 8 cases, in the right atria in 5 of 6 cases, in the VCC in 6 of 6 cases, and in the PV in 5 of 8 cases. Mild lesions of the muscular layer of the esophagus were found in 7 of 8 cases. CONCLUSIONS Epicardial cryoablation is not effective on thicker tissues like LAA and RAA due to the rewarming of the current blood flow. However, thin tissues like VCC and PV can be isolated. Further chronic studies are necessary to evaluate the potential for regeneration of adjacent structures.
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Affiliation(s)
- N Doll
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
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Kodera K, Kiaii B, Rayman R, Novick RJ, Boyd WD. Closed chest CABG on the beating heart with a computer-enhanced articulating system: case report. Heart Surg Forum 2002; 4:305-6. [PMID: 11827856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- K Kodera
- London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
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Kiaii B, Kodera K, Abu-Khudair W, Novick RJ, Boyd WD. An alternative arterial conduit for totally endoscopic multivessel coronary artery bypass. Heart Surg Forum 2002; 4:315-8. [PMID: 11827859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND The ultimate goal of coronary artery bypass grafting (CABG) is the performance of a totally endoscopic procedure using multiple arterial conduits. At our center we have been routinely performing endoscopic robotic harvesting of internal thoracic arteries (ITAs) for use in minimally invasive CABG. The right gastroepiploic artery (RGEA) has been shown to be a reliable and versatile arterial conduit for bypass to coronary vessels not easily accessible by an ITA. The RGEA has already been harvested less invasively through a small laparotomy. This procedure could be made even less invasive by harvesting the RGEA laparoscopically, but this procedure has not yet been reported. The purpose of this study was to develop an endoscopic technique for harvesting the RGEA and demonstrate the safety and efficacy of this less invasive approach. METHODS Twenty Duroc X Hampshire swine were administered general anesthesia and intubated. Ten mm and 5 mm trocars were then inserted. A 10 mm, 30-degree endoscope was adapted to a voice-activated robotic arm (AESOP), and the RGEA was harvested totally endoscopically using 5 mm harmonic scalpel shears. Intraoperative events and RGEA harvest times were recorded, and RGEA flows were measured after harvest. RGEA was delivered into the pericardial sac endoscopically. RESULTS All RGEAs were successfully harvested without injury. Harvest time averaged 29.9+/- 10.9 min. The harvested conduits averaged 24.7+/- 2.37 cm in length. Flows were excellent in all harvested conduits, averaging 81.1+/- 31.8 cc/min. The harmonic scalpel controlled all RGEA branches with excellent hemostasis. CONCLUSION The RGEA can be harvested safely through port access with robotic assistance. This conduit is of sufficient length to be used as an alternative arterial conduit for totally endoscopic multivessel coronary artery bypass.
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Affiliation(s)
- B Kiaii
- London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
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Kodera K, Boyd WD, Kiaii B, Novik RJ, Rayman R, Ganapathy S, Dobkowski WB, McKenzie NF, Menkis AH, Otsuka T, Yozu R. [Clinical experience in thoracoscopic left internal mammary artery harvesting with voice activated robotic assistance]. Kyobu Geka 2001; 54:987-91; discussion 991-4. [PMID: 11712382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Between September 1998 to February 2000, 45 consecutive patients underwent robotic-assisted, video-enhanced coronary artery bypass grafting. All IMA's were harvested using the voice-activated robotic assistant (AESOP 3000, Computer Motion Inc, Santa Barbara, CA) and the Harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH). Left IMA's were successfully harvested in all patients. Harvested IMA's were anastomosed to LAD's under direct vision through limited left anterior thoracotomy. The IMA harvest time was 57.8 +/- 23.2 min, intraoperative graft flow was 34.3 +/- 20.5 ml/min, postoperative hospital stay was 3.9 +/- 1.5 days. The early postoperative angiogram showed that all grafts were patent. There was no mortality, no significant morbidity. The robotic assisted, video enhanced CABG provides safe and complete LIMA dissection with minimal manipulation and assures sufficient LITA length for tension free anastomosis.
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Affiliation(s)
- K Kodera
- Department of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Canada
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Boyd WD, Kiaii B, Novick RJ, Rayman R, Ganapathy S, Dobkowski WB, Jablonsky G, McKenzie FN, Menkis AH. RAVECAB: improving outcome in off-pump minimal access surgery with robotic assistance and video enhancement. Can J Surg 2001; 44:45-50. [PMID: 11220798 PMCID: PMC3695183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To determine the efficacy of using the harmonic scalpel and robotic assistance to facilitate thoracoscopic harvest of the internal thoracic artery (ITA). DESIGN A case series. SETTING London Health Sciences Centre, University of Western Ontario, London, Ont. PATIENTS AND METHODS Fifteen consecutive patients requiring harvest of the ITA for coronary artery bypass grafting. INTERVENTION Robot-assisted, video-enhanced coronary artery bypass (RAVECAB) through limited-access incisions, using the harmonic scalpel and a voice-activated robotic assistant. MAIN OUTCOME MEASURES Ease and duration of the harvesting technique, complications of the procedure, graft flow and patency, and duration of postoperative hospitalization. RESULTS RAVECAB facilitated thoracoscopic dissection of the ITA with the harmonic scalpel in all cases. There were no conversions to a standard approach and no reoperations for bleeding. The mean (and standard deviation) ITA harvest time was 64.1 (22.9) minutes (range from 40 to 118 minutes). Robotic voice command capture rate was greater than 95%. Mean (and SD) intraoperative graft flows were 33.1 (26.8) mL/min (range from 14 to 126 mL/min). There was 100% graft patency on postoperative angiography. There were no deaths, perioperaive myocardial infarction or arrhythmias. Mean (and SD) postoperative hospitalization was 3.3 (0.8) days. CONCLUSIONS RAVECAB is a demanding procedure that addresses many of the disadvantages of the "conventional" minimally invasive coronary artery bypass. It allows complete pedicle dissection with minimal ITA manipulation and assures sufficient conduit length and a tension-free coronary artery anastomosis. All anastomoses were performed under direct vision through a 5- to 8-cm inferior mammary incision.
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Affiliation(s)
- W D Boyd
- London Health Sciences Centre, University of Western Ontario.
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Boyd WD, Rayman R, Desai ND, Menkis AH, Dobkowski W, Ganapathy S, Kiaii B, Jablonsky G, McKenzie FN, Novick RJ. Closed-chest coronary artery bypass grafting on the beating heart with the use of a computer-enhanced surgical robotic system. J Thorac Cardiovasc Surg 2000; 120:807-9. [PMID: 11003767 DOI: 10.1067/mtc.2000.109541] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- W D Boyd
- Division of Cardiothoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
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Boyd WD, Desai ND, Kiaii B, Rayman R, Menkis AH, McKenzie FN, Novick RJ. A comparison of robot-assisted versus manually constructed endoscopic coronary anastomosis. Ann Thorac Surg 2000; 70:839-42; discussion 842-3. [PMID: 11016320 DOI: 10.1016/s0003-4975(00)01738-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND New technology has enabled surgeons to attempt totally endoscopic coronary artery bypass grafting. Our purpose was to compare three different techniques of totally endoscopic anastomosis using a porcine animal model. METHODS Porcine hearts were excised and the right coronary artery was dissected free for use as an arterial graft. The hearts were placed in a human thoracic model and an endoscopic arterial anastomosis between the free right coronary artery and the left anterior descending coronary artery was performed using one of the following: (1) two-dimensional visualization with straight endoscopic instruments (n = 8); (2) three-dimensional head-mounted visualization with curved endoscopic instruments (n = 7); or (3) three-dimensional visualization with robotic telemanipulation (n = 8). Pathologic analysis of suture placement, vessel trauma, and patency was performed. Anastomoses were graded according to quality, ease, and patency using a seven-point Likert scale (1 = excellent, 7 = very poor). RESULTS Endoscopic anastomotic ease and quality were significantly improved when three-dimensional visualization and curved endoscopic instruments were employed. Telemanipulation enhanced the process and provided the best operative results with regard to time required to construct the anastomosis, as well as ease and quality. CONCLUSIONS Totally endoscopic anastomosis is feasible using currently available technology. Three-dimensional visualization and robotic telemanipulation significantly facilitate anastomosis construction and will likely benefit clinical operative outcome.
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Affiliation(s)
- W D Boyd
- Division of Cardiothoracic Surgery, London Health Sciences Centre, University of Western Ontario, Canada.
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Abstract
Progesterone suppresses gallbladder smooth muscle function but its exact mechanism is unknown. We sought to determine the cellular site where progesterone impairs gallbladder smooth muscle. Sixty-four adult male guinea pigs were injected with either progesterone (2 mg/kg/day sc) or normal saline (controls) for 7 days. Dose-response curves of gallbladder strips to cholecystokinin (CCK), bethanechol, and potassium (K+) were constructed in vitro. To better define the basis for the progesterone effect, gallbladder contractile response was determined to specific agonists: aluminum fluoride and mastoparan (direct G-protein activators), cyclopiazonic acid (CPA), and a calcium ionophore (A-23187). Gallbladder from animals on progesterone exhibited a marked decrease in contractile response to CCK and bethanechol compared with controls (P < 0.05). Further, gallbladder contraction remained depressed (P < 0.05) in progesterone-treated animals, when the G protein was directly activated with aluminum fluoride and mastoparan. In contrast, the responses to K+ (acting independent of receptor G-protein) and to A-23187 and CPA (agonists that bypassed the membrane) were comparable in both groups (NS). It is concluded that progesterone directly inhibits gallbladder smooth muscle contractility in vitro to a standard hormone, CCK, and a cholinergic agent. Such depressed contraction is not due to an altered contractile machinery, since it is normal with agonists that act independently of G-protein activation. Progesterone thus interferes with signaling through the G-protein, either by directly becoming closely associated with the cell membrane or by indirectly perturbing its receptor products.
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Affiliation(s)
- B Kiaii
- Department of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
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