Da Vinci hearts

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bullard

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We may start doing some of these at my place in a few months. Any pointers or things to watch out for?
 
bullard said:
We may start doing some of these at my place in a few months. Any pointers or things to watch out for?
Click to expand...

Yeah, watch out for 5-6 hour pump runs.

A mini thoracotomy is so much better than the stupid robot for "less invasive" procedures, in my opinion having been around high volume centers of both flavors.

I think it's inexcusable to expose the patient to longer pump runs to achieve what are often inferior surgical results.
 
Yeah, right thoracotomy for MVR in good surgical hands is a great case. As is left thoracotomy for OPCABG.
 
Made the jump to robotic thoracotomies.

From a professional/academic point of view, I wish we did robotic hearts now. We are a couple of years (or more) away from that.

Cool stuff. I'd embrace it if it came my way. Some dudes are doing perc. ventricular assist devices. Daaammmnn... that's slick! Hope you guys in residency/academics/pp are having a good time with it. 👍
 
You guys been busy in your CVOR's? We've been crazy busy. 3 emergent widow makers came in at the same time yesterday... then again today. That's on top of our regular scheduled cases. Doing more and more... weird.
 
proman said:
TECAB or valves? How minimally invasive (will you need the Endovent and Endoplege?) What's the experience of the surgeon plus that of the team?
Click to expand...

Not sure yet on most of that. Can't really figure out the surgeon's focus -- he's done everything from valves to transplants but hasn't done a robot case in a while. But we just started doing da Vinci gyne and uro cases so the pressure will be on to use it in the chest as well.

I'm guessing the Endoplege is a coronary sinus catheter that you insert from the R IJ? Visualizing the sinus on TEE is no problem for me, but how do you steer the catheter into it?
 
bullard said:
Not sure yet on most of that. Can't really figure out the surgeon's focus -- he's done everything from valves to transplants but hasn't done a robot case in a while. But we just started doing da Vinci gyne and uro cases so the pressure will be on to use it in the chest as well.

I'm guessing the Endoplege is a coronary sinus catheter that you insert from the R IJ? Visualizing the sinus on TEE is no problem for me, but how do you steer the catheter into it?
Click to expand...

Same way the surgeon steers it in there- poke, poke, poke, there it goes. The ones I've worked with are a little stiffer than a Swan, with a little more memory. It can easily be the rate-limiting step of your induction. One of the reps, from Edwards I believe, has a pretty nice monograph written solely to aid in placing them.

And from my experience at a smaller hospital, once Gyn and Uro get a hold of the DaVinci, good luck getting time booked on that machine.
 
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sevoflurane said:
Made the jump to robotic thoracotomies.

From a professional/academic point of view, I wish we did robotic hearts now. We are a couple of years (or more) away from that.

Cool stuff. I'd embrace it if it came my way. Some dudes are doing perc. ventricular assist devices. Daaammmnn... that's slick! Hope you guys in residency/academics/pp are having a good time with it. 👍
Click to expand...

Perc VADs (impellas) aren't really all that exciting. They move pretty fast.
 
Coastie said:
Perc VADs (impellas) aren't really all that exciting. They move pretty fast.
Click to expand...

That's exactly what I'm saying Coastie!

I remember long nights of RVADS/LVADS/BiVADS + bring backs. To do it percutaneously in a matter of seconds is supah slick! 😉
 
LVADS are being placed off-pump now as well. Seen a couple videos at the SCA meeting and I have to say... I was impressed. They make it look easy.
 
Tandemhearts are only for temporary support though and the amount of flow is not impressive.

Now off-pump lvads...that is something!
 
bullard said:
Tandemhearts are only for temporary support though and the amount of flow is not impressive.

Now off-pump lvads...that is something!
Click to expand...

The two VAD surgeons here do them with ~30 min pump runs. The key is to do the outflow cannula first then CPB and do the inflow. So much easier. Tying good knots helps too.

bullard said:
Not sure yet on most of that. Can't really figure out the surgeon's focus -- he's done everything from valves to transplants but hasn't done a robot case in a while. But we just started doing da Vinci gyne and uro cases so the pressure will be on to use it in the chest as well.

I'm guessing the Endoplege is a coronary sinus catheter that you insert from the R IJ? Visualizing the sinus on TEE is no problem for me, but how do you steer the catheter into it?
Click to expand...

If you're going to do the Endoplege you really need to do the Edwards training. 2 days at a location that does a lot of them, several hours of watching/talking about them etc. The next generation of Endoplege will have a steerable tip which should be easier. I think the use of fluoro helps ensure appropriate position (doesn't help it get to the ostium, TEE for that).
 
They better ensure that training location is sunny and on the beach. 🙂
 
Robot OPCAB - can they do anything besides the LAD? We tried a few, but had a massive hemorrhage from the IMA Dissection. Takes FOREVER to open the chest.
 
Oggg said:
Robot OPCAB - can they do anything besides the LAD? We tried a few, but had a massive hemorrhage from the IMA Dissection. Takes FOREVER to open the chest.
Click to expand...

LIMA-LAD is the most common for OPCAB. We've learned to put the venous line and do axillary or femoral artery cannulation prior to starting so we can just go on CPB if something happens.
 
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Most single vessel LADs get stented, so I don't see the benefit of robot LIMA LAD
 
Oggg said:
Robot OPCAB - can they do anything besides the LAD? We tried a few, but had a massive hemorrhage from the IMA Dissection. Takes FOREVER to open the chest.
Click to expand...

Interesting. Our surgeon is completely bloodless. There is a learning curve and there must be the will because the road is rocky.
 
Oggg said:
Most single vessel LADs get stented, so I don't see the benefit of robot LIMA LAD
Click to expand...

We've been doing hybrid procedures. Cardiologists stent the back side, then robot OPCAB LIMA-LAD. It has been argued that LIMA graft is superior to stent and the procedure is actually minimally invasive. Anybody else doing it this way?
 
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