Outcomes following the first 100 cases of a new robotic mitral valve program

JTCVS Open · 2026-04-01

Robotic Mitral Valve Repair With Severe Pectus Excavatum

JACC Case Reports · 2026-05-01

Pectus excavatum is a relative contraindication to robotic cardiac surgery given the challenges of access and exposure. We present 3 cases of successful robotic mitral valve repair in patients with degenerative mitral regurgitation and severe pectus excavatum.

Outcomes following isolated right ventricular assist device as durable support for primary right heart failure: An INTERMACS analysis

JHLT Open · 2025-04-02

Outcomes with isolated right ventricular assist devices (iRVAD) using pumps designed for the left ventricle are not well described. This study compares the clinical characteristics and outcomes of iRVAD patients to those patients treated with left ventricular assist device (LVAD) and biventricular assist devices (BiVAD). This study consisted of patients who received iRVAD from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry (2006-2017). The primary outcome was 2-year survival. Of 20,789 patients, 26 (0.13%) received iRVAD, 17 with pulsatile flow and 9 with continuous-flow devices. Device strategy was bridge to recovery/rescue therapy in 9 (35%), bridge to transplant/decision in 14 (52%), and destination therapy in 3 (12%). Twelve (46%) patients were INTERMACS profile 1, 5 patients (19%) required extracorporeal membrane oxygenation, and 13 (50%) needed mechanical ventilation. Two-year survival for patients with iRVAD (41.3%) was similar to BiVAD (45.2%) and significantly lower than LVAD (69.0%). In patients with isolated right-sided failure, long-term iRVAD support is feasible.

Association Between Preoperative Palmar Arch Velocity on Duplex Ultrasonography and Ischemic Hand Symptoms After Radial Artery Harvest

The Annals of Thoracic Surgery · 2025-11-20 · 1 citations

BACKGROUND: Duplex ultrasonography is often used to assess radial artery suitability for coronary artery bypass grafting, but clear guidelines for its usage are lacking. This study investigates the association between preoperative arterial velocity characteristics and postoperative ischemic hand symptoms after endoscopic radial artery harvest. METHODS: We performed a retrospective review of 584 patients who underwent coronary artery bypass grafting with a radial artery graft from 2016 to 2023. Using preoperative duplex ultrasonography, patients were categorized based on their palmar arch reversal velocity during radial artery occlusion: normal (>20 cm/s), marginal (10-20 cm/s), or low (<10 cm/s). The primary outcome was any report of ischemic hand symptoms (pain, weakness, or sensation loss) at the 30-day postoperative follow-up. RESULTS: Of the 584 patients, 421 (72.1%) had normal flow, 139 (23.8%) had marginal flow, and 24 (4.1%) had low flow. The overall incidence of ischemic hand symptoms at 30 days was low at 5.8% (34 patients). There was no significant association between preoperative palmar arch reversal velocity and postoperative symptoms (odds ratio, 1.56 for combined marginal/low flow vs normal; 95% CI, 0.84-2.85). No ischemic events requiring intervention occurred. On multivariable analysis, only diabetes was associated with an increased risk of symptoms (odds ratio, 1.98; 95% CI, 1.11-3.59). CONCLUSIONS: Low palmar arch reversal velocity on preoperative duplex ultrasonography was not associated with an increased risk of hand ischemia after radial artery harvest. These findings suggest that harvesting the radial artery is safe in patients with marginal or even low flow, provided ulnar collateral circulation is adequate.

Quality of life after mitral valve surgery: Results from the Cardiothoracic Surgical Trials Network

Journal of Thoracic and Cardiovascular Surgery · 2025-08-28

Outcomes of Re-Repair vs Replacement After Failed Primary Mitral Regurgitation Repair: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis

The Annals of Thoracic Surgery · 2025-11-22 · 1 citations

Quantifying Sleep-Wake Rhythms in the Hospital Environment with Digital Technologies

npj Digital Medicine · 2025-11-22

Postoperative clinical care is prone to circadian desynchronization that may influence health outcomes. In an exploratory, feasibility-oriented and signal-exploration effort, we collected 1.8 million data points using 11 remote sensors during preoperative, in-hospital and post-discharge settings in 13 elective cardiac surgery patients (5.2% enrolled from 252 screened). We found that room traffic continued during nighttime with ≥1 visit/h. Sound levels exceeded the recommended 45 dBA threshold (51.9 ± 3.3 vs. 48.3 ± 4.2 dBA during nighttime). Brightness dropped at night (89.9 ± 87.7 to 3.7 ± 9.8 lux), but bright light exposures occurred. Ambient room temperature lacked sleep-inducing diurnal variability. Behavioral-physiological rhythms were disrupted and phase-shifted during hospitalization. Time awake during night hours increased from 10.7 ± 7.9% preoperatively to 34.8 ± 29.1% in-hospital. Cognitive function scores decreased (26.8 ± 2.8 points preoperatively to 24.7 ± 3.9 points in-hospital) with 31% of patients developing transient mild impairment. These data will inform the design of a controlled trial seeking to modify circadian/diurnal disruptors to enhance patient outcomes. Clinicaltrials.gov NCT05828680, November 21, 2022.

Approach to Severe Mitral Annular Calcification Using Ultrasonic Aspiration

Operative Techniques in Thoracic and Cardiovascular Surgery · 2024-01-01 · 2 citations

Anaerobic Lactate Production Is Associated With Decreased Microcirculatory Blood Flow and Decreased Mitochondrial Respiration Following Cardiovascular Surgery With Cardiopulmonary Bypass*

Critical Care Medicine · 2024-04-05 · 9 citations

OBJECTIVES: Quantify the relationship between perioperative anaerobic lactate production, microcirculatory blood flow, and mitochondrial respiration in patients after cardiovascular surgery with cardiopulmonary bypass. DESIGN: Serial measurements of lactate-pyruvate ratio (LPR), microcirculatory blood flow, plasma tricarboxylic acid cycle cycle intermediates, and mitochondrial respiration were compared between patients with a normal peak lactate (≤ 2 mmol/L) and a high peak lactate (≥ 4 mmol/L) in the first 6 hours after surgery. Regression analysis was performed to quantify the relationship between clinically relevant hemodynamic variables, lactate, LPR, and microcirculatory blood flow. SETTING: This was a single-center, prospective observational study conducted in an academic cardiovascular ICU. PATIENTS: One hundred thirty-two patients undergoing elective cardiovascular surgery with cardiopulmonary bypass. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients with a high postoperative lactate were found to have a higher LPR compared with patients with a normal postoperative lactate (14.4 ± 2.5 vs. 11.7 ± 3.4; p = 0.005). Linear regression analysis found a significant, negative relationship between LPR and microcirculatory flow index ( r = -0.225; β = -0.037; p = 0.001 and proportion of perfused vessels: r = -0.17; β = -0.468; p = 0.009). There was not a significant relationship between absolute plasma lactate and microcirculation variables. Last, mitochondrial complex I and complex II oxidative phosphorylation were reduced in patients with high postoperative lactate levels compared with patients with normal lactate (22.6 ± 6.2 vs. 14.5 ± 7.4 pmol O 2 /s/10 6 cells; p = 0.002). CONCLUSIONS: Increased anaerobic lactate production, estimated by LPR, has a negative relationship with microcirculatory blood flow after cardiovascular surgery. This relationship does not persist when measuring lactate alone. In addition, decreased mitochondrial respiration is associated with increased lactate after cardiovascular surgery. These findings suggest that high lactate levels after cardiovascular surgery, even in the setting of normal hemodynamics, are not simply a type B phenomenon as previously suggested.

Strategic implementation of a new robotic mitral repair program: Early experience and outcomes

Journal of Thoracic and Cardiovascular Surgery · 2024-10-08 · 1 citations