The use of a mini bypass system (Cobe Synergy) without venous and cardiotomy                 reservoir in a mitral valve repair: a case report

The use of mini cardiopulmonary bypass circuits is an emerging technology. The venous and cardiotomy reservoir have been excluded from the circuit. This results in a reduction of the blood contact surface area and of the priming volume. Entrainment of venous air, however, remains a drawback in the widespread acceptance of using these mini circuits. The technique described resolves this problem by automatic removal of venous air, and explains how this mini cardiopulmonary bypass circuit was utilized on a 64-year-old female presented for a mitral valve repair. In the absence of a cardiotomy reservoir, an autotrans-fusion cell separator was used to process shed blood and, after CPB, the residual pump blood. This mini bypass circuit, with the safety feature to remove automatically venous air, provided an additional degree of protection. In our experience, mini bypass circuits allow us safely to perform cardiopulmonary bypass during valve procedures.

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The Use of the Mini-Cardiopulmonary Bypass Circuit in Robotic Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/01.imi.0000312975.89468.8f ◽

2008 ◽

Vol 3 (1) ◽

pp. 16-18 ◽

Cited By ~ 3

Author(s):

Robert W. Emery ◽

Goya V. Raikar ◽

Barbara Murphy ◽

Anton Rohan ◽

Kris Nielsen

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Valve Repair ◽

High Efficiency ◽

Mitral Valve Surgery ◽

Circulatory Support ◽

Valve Repair ◽

Mitral Repair ◽

Perfusion Time ◽

Mitral Surgery

Background Computer enabled robotic mitral valve repair cases have longer cross-clamp and perfusion times because of the more technically difficult procedure. To modify some of the well-documented side effects of standard cardiopulmonary bypass (CPB), we used a new mini-circuit on three robotic mitral cases. Methods Three patients having mitral valve repair (triangular resection of P2 and annuloplasty ring) using the daVinci Robot (Intuitive Surgical, Sunnyvale, CA) had circulatory support using a modified Resting Heart System (Medtronic, Inc., Fridley, MN), a vertically oriented space saving CPB configuration incorporating a high efficiency miniaturized oxygenator, centrifugal pump, shortened heparin coated tubing and an air evacuation system with a closed circuit. Results All patients had successful mitral repair (echo = 0 to trace residual leakage) under a cross-clamp time of 161 ± 54 minutes and perfusion time of 229 ± 31 minutes. No blood was given during CPB and 0.7 ± 1.2 red cell units after the CPB run and 0.7 ± 1.2 units during the postoperative course. Conclusion Miniaturized bypass circuit reducing the level of necessary anticoagulation, hemodilation, and blood trauma can be used despite the increased perfusion time necessary for robotic mitral surgery.

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Aortic Valve Remaining Open During Cardiopulmonary Bypass in Robot-Assisted Mitral Valve Repair: A Rare Life-Threatening Situation

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2019.05.011 ◽

2019 ◽

Vol 33 (9) ◽

pp. 2607-2608

Author(s):

Kazuto Miyata ◽

Sayaka Shigematsu ◽

Norihiko Ishikawa ◽

Go Watanabe

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Aortic Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Robot Assisted ◽

Life Threatening ◽

Threatening Situation

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Complex Bileaflet Mitral Valve Repair (Barlow's) Using the da Vinci Robotic Surgical System

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/01.imi.0000233280.92291.68 ◽

2006 ◽

Vol 1 (5) ◽

pp. 276-278 ◽

Cited By ~ 1

Author(s):

Saqib Masroor ◽

L. Wiley Nifong ◽

W. Randolph Chitwood

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Da Vinci ◽

Left Ventricular ◽

Valve Repair ◽

Long Term Follow Up ◽

Robotic Surgical System ◽

Surgical System

Robotic mitral valve repair (RMVR) is less invasive and potentially more precise. However, RMVR lengthens both cardiopulmonary bypass and arrested heart times. In our initial experience, only posterior leaflet repair and/or annuloplasty were performed. With increasing experience, we have performed more complex bileaflet RMVR. A 50-year-old man presented with severe mitral regurgitation. Transesophageal echocardiography (TEE) demonstrated a complex bileaflet prolapse and preserved left ventricular function. Through a 4 cm working port and with the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA) RMVR was performed. Details of the technique and patient's hospital course are described. The repair comprised closure of clefts between A3 and P3, quadrangular resection of P2, transfer of multiple chords from P2 to A2/A3 and a #38 Cosgrove-Edwards (Edwards Lifesciences, Irvine, CA) band annuloplasty. Nitinol U-Clips (Medtronic, Minneapolis, MN) were used to complete the annuloplasty. Postoperative TEE showed no mitral regurgitation. The patient was discharged on the third postoperative day. Cardiopulmonary bypass and arrested heart times were 3 hours and 29 minutes and 2 hours and 59 minutes, respectively. Complex bileaflet repair of mitral valve with Barlow's disease can be successfully performed with the da Vinci Robotic Surgical System. Long-term follow-up is needed to assess the durability of repair.

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Mitral Valve Repair Under Cardiopulmonary Bypass

Advances in Small Animal Medicine and Surgery ◽

10.1016/j.asams.2012.10.003 ◽

2012 ◽

Vol 25 (11) ◽

pp. 3-4

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

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Perioperative management of a patient with glanzmann's thrombasthenia for mitral valve repair under cardiopulmonary bypass

Annals of Cardiac Anaesthesia ◽

10.4103/0971-9784.216245 ◽

2017 ◽

Vol 20 (4) ◽

pp. 468 ◽

Cited By ~ 1

Author(s):

ParimalaPrasanna Simha ◽

PrasannaSimha Mohan Rao ◽

Deepak Arakalgud ◽

Rakesh Rajashekharappa ◽

Manjunath Narasimhaih

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Perioperative Management ◽

Valve Repair ◽

Glanzmann’S Thrombasthenia ◽

Glanzmann's Thrombasthenia

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The Impact of Aorto-mitral Angle on New Onset Atrial Arrhythmia after Mitral Valve Repair in Patients with Mitral Regurgitation

10.22541/au.161322131.18603327/v1 ◽

2021 ◽

Author(s):

Shunsuke Kagawa ◽

Yukio Abe ◽

Yoshiki Matsumura ◽

Nanaka Nomura ◽

Kenji Shimeno ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Odds Ratio ◽

Atrial Arrhythmia ◽

Valve Repair ◽

Mitral Annuloplasty ◽

New Onset

Background: We hypothesized that the post-operative aorto-mitral angle might relate to the occurrence of post-operative atrial arrhythmia (AA), including atrial fibrillation and atrial tachycardia, after mitral valve repair in patients with mitral regurgitation (MR). The purpose of the present study was to determine the effects of the post-operative aorto-mitral angle on new onset AA after mitral valve repair with mitral annuloplasty for treating MR. Methods: One-hundred seventy-two patients without any history of AA underwent mitral valve repair with mitral annuloplasty in our institution between 2008 and 2017. Patient information, including medical records and echocardiographic data, were retrospectively studied. Results: AA occurred in 15 (8.7%) patients during the follow-up period (median, 35.7 months; range, 0.5-132 months). The patients with AA had a longer cardiopulmonary bypass time and a smaller aorto-mitral angle at post-operative TTE than the others (119 ± 6 degrees vs. 125 ± 10 degrees, P = 0.003). There was no significant difference in the degree of post-operative residual MR or functional MS between the groups. In a multivariate Cox proportional hazards analysis, the longer cardiopulmonary bypass time and the smaller post-operative aorto-mitral angle were independent predictors of the occurrence of AA during the follow-up period (odds ratio per 10 minutes 1.11; 95% CI 1.02-1.22, P = 0.019: odds ratio 0.91; 95% CI 0.85-0.98, P = 0.012). Conclusion: A small aorto-mitral angle at post-operative TTE was a predictor of new onset AA after a mitral valve repair for treating MR.

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Mitral Valve Repair without Cardiopulmonary Bypass or Atriotomy Using the Coapsys Device: Device Design and Implantation Procedure in Canine Functional Mitral Regurgitation Model

The Heart Surgery Forum ◽

10.1532/hsf98.200344395 ◽

2004 ◽

Vol 7 (2) ◽

pp. 69-73 ◽

Cited By ~ 8

Author(s):

Masahiro Inoue ◽

Patrick M. McCarthy ◽

Zoran B. Popovi´c ◽

Kazuyoshi Doi ◽

Soren Schenk ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Functional Mitral Regurgitation ◽

Device Design ◽

Valve Repair ◽

Implantation Procedure

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Use of an automated knot fastener shortens operative times in minimally invasive mitral valve repair

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0063 ◽

2019 ◽

Vol 101 (7) ◽

pp. 522-528 ◽

Cited By ~ 3

Author(s):

G Perin ◽

M Shaw ◽

V Pingle ◽

K Palmer ◽

O Al-Rawi ◽

...

Keyword(s):

Renal Failure ◽

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Postoperative Outcomes ◽

Valve Repair ◽

Aortic Cross Clamp ◽

Logistic Euroscore ◽

Significant Difference

Introduction Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. Materials and methods All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2016 were included (n = 108). Two cohorts were created based on the use (n = 52) or non-use (n = 56) of an automated knot fastener. Data concerning intraoperative variables and postoperative outcomes were collected and compared. Results Preoperative demographics were well matched between groups with no significant difference in logistic Euroscore (manual vs automated: median 3.1, interquartile range, IQR, 2.1–5.5, vs 5.4, IQR 2.2–8.3; P = 0.07, respectively). Comparing manually tied knots to an automated fastener, cardiopulmonary bypass and aortic cross clamp times were significantly shorter in the automated group (cardiopulmonary bypass: median 200 minutes, IQR 180–227, vs 165 minutes (IQR 145–189 minutes), P < 0.001; aortic cross clamp 134 minutes (IQR 121–150 minutes) vs 111 minutes (IQR 91–137 minutes), P < 0.001, respectively). There was no mortality and no strokes, nor were there any differences in postoperative outcomes including reoperation for bleeding, renal failure, intensive care or hospital stay. Conclusions The use of an automated knot fastener significantly reduces cardiopulmonary bypass and aortic cross clamp times in minimally invasive mitral valve repair but this does not translate into an improved clinical outcome.

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