The Preferable Use of Port Access Surgical Technique for Right and Left Atrial Procedures

2005 ◽  
Vol 8 (5) ◽  
pp. E354-E363 ◽  
Author(s):  
B. Gersak ◽  
M. Sostaric ◽  
J. M. Kalisnik ◽  
R. Blumauer
Keyword(s):  
Surgical Technique ◽  
Left Atrial ◽  
Port Access

scholarly journals A Comparative Study Between Different Surgical Techniques For Left Atrial Exclusion in Patients Undergoing Concomitant Cardiac Surgery

2021 ◽  
Vol 24 (5) ◽  
pp. E901-E905
Author(s):  
Ahmed Abdeljawad ◽  
Yasser Shaban Mubarak
Keyword(s):  
Cardiac Surgery ◽  
Surgical Technique ◽  
Left Atrial ◽  
Oral Anticoagulants ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Thromboembolic Events ◽  
Purse String Suture ◽  
Purse String ◽  
Suture Ligation

Objectives: To find out the most successful surgical technique to obliterate left atrial appendage (LAA) in atrial fibrillation (AF) patients who had undergone concomitant cardiac surgery. Background: About 10%-65% of patients develop AF following cardiac surgery [Rho 2009; Mathew 2004; Maesen 2012]. Cerebral cardio-embolic stroke remains the most serious complication in AF patients. LAA is the main anatomical source for thromboembolic events. The use of oral anticoagulants (OAG) is considered to be an effective method for reduction of thromboembolic complications [Johnson 2000]. The use of oral anticoagulants is faced by two important facts which are the therapy duration is still unknown [Kirchhof 2017] and importantly that between 30-50% of patients are not candidates for oral anticoagulants due to the high bleeding risk or other contraindications [Johnson 2000; Kirchhof 2017; Kirchhof 2014]. In such patients, LAA obliteration would be an optimal alternative technique as it will reduce the stroke risk by 50% [Go 2014]. Several surgical techniques with variable degrees of success rates have been used.  It still is unclear which surgical technique is optimum to achieve a successful obliteration of the LAA and a considerable reduction of the postoperative stroke events in AF patients. Patients and methods: A total of 100 patients have been subjected to surgical LAA exclusion from April 2017 to April 2019 in two different centers. All patients had postoperative transesophageal echo (TEE) examination to confirm the success of LAA occlusion. All patients included in our study suffered from AF at the time of surgery or in past history, which was confirmed by ECG examination in their previous medical files. A variety of surgical techniques to close the LAA have been utilized, including surgical excision by means of scissors, patch exclusion by means of an endocardial patch, suture exclusion and finally stapler exclusion. TEE examination 16 months postoperatively divided our patients into four groups as follows: successful LAA occlusion, Patent LAA, excluded LAA with persistent flow into LAA, and remnant LAA with a stump connection with LAA more than 1 cm. Results: Out of 100 patients, 30 patients (30%) underwent surgical LAA excision, 24 patients (24%) underwent surgical epicardial suture ligation, eight patients (8%) underwent patch exclusion using autologous pericardial patch, 33 patients (33%) underwent LAA internal orifice purse string suture obliteration, and five patients (5%) underwent stapler exclusion. Forty-two patients out of 100 (42%) showed successful LAA closure. The successful LAA occlusion occurred mostly in LAA excision patients 87%, 24% in LAA internal orifice purse string suture obliteration patients, 21% in epicardial suture ligation patients, and 37.5% in patch exclusion patients. The stapler exclusion was very disappointing as we did not record a single case out of the five patients who showed a successful LAA occlusion. Stroke events were recorded in all surgical techniques except the LAA excision technique. The stroke rate after two years follow up was zero in the surgical excision group, 49% in the suture exclusion group, 20% in the patch exclusion group, and 40% in stapler exclusion group. Conclusion: Surgical LAA excision is the most successful technique for LAA occlusion and represents a promising technique for the reduction of thromboembolic events in AF patients who undergo a concomitant cardiac surgery.

scholarly journals Extraction through Minimal Invasive Partially Video-Assisted Anterolateral Right Thoracotomy of a Voluminous Left Atrial Thrombus Due to Unregulated Warfarin Treatment

2019 ◽  
pp. 1-3
Author(s):  
Sotirios Marinakis ◽  
Badih EL NAKADI ◽  
Serge CAPPELIEZ ◽  
Marc JORIS ◽  
Sotirios Marinakis ◽  
...  
Keyword(s):  
Left Atrial ◽  
Minimal Invasive ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Video Assisted ◽  
Port Access ◽  
Warfarin Treatment ◽  
History Of ◽  
Residual Thrombus ◽  
Midline Sternotomy

A 62-year-old female patient with history of atrial fibrillation and protein C and S deficiency was admitted for acute dyspnea. Laboratory control demonstrated an unregulated warfarin treatment. Transthoracic echocardiography and computed tomography revealed a giant left atrial thrombus and a severe mitral stenosis. The day after admission a full body tomography revealed spleen emboli and non-violation of hematoencephalic barrier. Surgical thrombus extraction and mitral valve replacement were successfully performed by minimal invasive, partially video-assisted, right anterolateral thoracotomy. Echocardiographic control after two months showed no evidence of residual thrombus. Massive left atrial thrombosis must be operated urgently because of the imminent risk of embolization. The described technique represents a good compromise between full video-assisted port-access surgery and traditional midline sternotomy.

A novel surgical technique of left atrial appendage closure

2020 ◽  
Vol 35 (9) ◽  
pp. 2137-2141
Author(s):  
Eilon Ram ◽  
Boris Orlov ◽  
Leonid Sternik
Keyword(s):  
Surgical Technique ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure

scholarly journals Finite Element Modeling of the Left Atrium to Facilitate the Design of an Endoscopic Atrial Retractor

2007 ◽  
Vol 129 (6) ◽  
pp. 825-837 ◽  
Author(s):  
S. R. Jernigan ◽  
G. D. Buckner ◽  
J. W. Eischen ◽  
D. R. Cormier
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Finite Element Model ◽  
Left Atrium ◽  
Left Atrial ◽  
Element Model ◽  
Surgical Instruments ◽  
Element Analysis ◽  
Atrial Tissue ◽  
Port Access

With the worldwide prevalence of cardiovascular diseases, much attention has been focused on simulating the characteristics of the human heart to better understand and treat cardiac disorders. The purpose of this study is to build a finite element model of the left atrium (LA) that incorporates detailed anatomical features and realistic material characteristics to investigate the interaction of heart tissue and surgical instruments. This model is used to facilitate the design of an endoscopically deployable atrial retractor for use in minimally invasive, robotically assisted mitral valve repair. Magnetic resonance imaging (MRI) scans of a pressurized explanted porcine heart were taken to provide a 3D solid model of the heart geometry, while uniaxial tensile tests of porcine left atrial tissue were conducted to obtain realistic material properties for noncontractile cardiac tissue. A finite element model of the LA was constructed using ANSYS™ Release 9.0 software and the MRI data. The Mooney–Rivlin hyperelastic material model was chosen to characterize the passive left atrial tissue; material constants were derived from tensile test data. Finite element analysis (FEA) models of a CardioVations Port Access™ retractor and a prototype endoscopic retractor were constructed to simulate interaction between each instrument and the LA. These contact simulations were used to compare the quality of retraction between the two instruments and to optimize the design of the prototype retractor. Model accuracy was verified by comparing simulated cardiac wall deflections to those measured by MRI. FEA simulations revealed that peak forces of approximately 2.85N and 2.46N were required to retract the LA using the Port Access™ and prototype retractors, respectively. These forces varied nonlinearly with retractor blade displacement. Dilation of the atrial walls and rigid body motion of the chamber were approximately the same for both retractors. Finite element analysis is shown to be an effective tool for analyzing instrument/tissue interactions and for designing surgical instruments. The benefits of this approach to medical device design are significant when compared to the alternatives: constructing prototypes and evaluating them via animal or clinical trials.

Left Atrial Mass Causing Obstruction After Retransplantation: Case Report and Surgical Technique

2014 ◽  
Vol 46 (7) ◽  
pp. 2467-2468
Author(s):  
P.O. Dionne ◽  
C. Ayoub ◽  
L.P. Perrault ◽  
M. Carrier
Keyword(s):  
Case Report ◽  
Surgical Technique ◽  
Left Atrial ◽  
Atrial Mass

1690: Orthotopic Renal Transplant: An Alternative Surgical Technique in Selected Cases

2006 ◽  
Vol 175 (4S) ◽  
pp. 544-544
Author(s):  
Mireia Musquera ◽  
Anna Agud ◽  
Lluis Peri ◽  
Maria Jose Ribal ◽  
Federico Oppenheimer ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Surgical Technique
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