The aim of the study was to create an anatomical correct 3D rapid prototyping model (RPT) for patients with complex heart disease and altered geometr

Surgical performance is limited by human factors. Beating-heart surgery requires full dexterity and motion tracking. Currently techniques for total endoscopic beating-heart bypass grafting using telemanipulation systems are being developed. The aim of this study was to assess the limitations for manual and telemanipulator-assisted motion tracking using the da Vinci telemanipulator system. To simulate beating-heart conditions an endoscopic trainer was developed. Twenty subjects were asked to touch targets manually and with telemanipulator assistance with different patterns of increasing index of difficulty (resting model, unstabilized, and stabilized model with a frequency of 35, 60, and 90 beats per minute). In addition one task was performed using different scaling ratios on a resting model. The times between hits as well as errors were electronically recorded. There was no significant impact of various frequencies and amplitudes for manual tracking. The average values for the delay (k_m[ms]) and information-processing (c_m [ms/bit]) constants for the manual tasks were 201 ms and 86 ms/bit respectively. Both the delay constant (k_t = 630 ms; p < 0.0005) and the information-processing constant (c_t = 250 ms/bit; p < 0.0005) were increased for the telemanipulator-assisted tasks at rest. When working on moving targets telemanipulator-assisted tracking required significantly more time and led to more errors. At a frequency of 90 beats per minute telemanipulator-assisted tracking became more difficult. Endoscopic beating-heart bypass grafting requires optimal stabilization to avoid inaccuracies due to incomplete motion tracking. At higher frequencies telemanipulator-assisted tracking became more difficult, demonstrating the technical limits of current telemanipulator technology.

Background: Takotsubo syndrome is, by definition, a reversible form of acute heart failure. If cardiac output is severely reduced, Takotsubo syndrome can cause cardiogenic shock, and mechanical circulatory support can serve as a bridge to recovery. To date, there are no recommendations on when to use mechanical circulatory support and on which device is particularly effective in this context. Our aim was to determine the best treatment strategy. Methods: A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023. Results: A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001). Conclusions: Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.

OBJECTIVES: Analyses of fast-track (FT) processes demonstrated that low-risk cardiac surgical patients require minimal intensive care, with a low incidence of mortality or morbidity. We investigated perioperative factors and their association with fast-track failure (FTF) in a retrospective cohort study of patients undergoing minimally invasive mitral valve surgery. METHODS: Patients undergoing minimally invasive surgical mitral valve repair for Carpentier type I or type II mitral regurgitation between 2014 and 2020 were included in the study. The definition of FTF consisted of >10 h mechanical ventilation, >24 h intensive care unit stay, reintubation after extubation and re-admission to the intensive care unit. Multivariable logistic regression analysis enabled the identification of factors associated with FTF. RESULTS: In total, 491 patients were included in the study and were analysed. Two hundred and thirty-seven patients (48.3%) failed the FT protocol. Multivariable logistic regression analysis showed that a New York Heart Association classification ≥III [odds ratio (OR) 2.05; 95% confidence interval (CI) 1.38–3.08; P < 0.001], pre-existing chronic kidney disease (OR 2.03; 95% CI 1.14–3.70; P = 0.018), coronary artery disease (OR 1.90; 95% CI 1.13–3.23; P = 0.016), postoperative bleeding requiring surgical revision (OR 8.36; 95% CI 2.81–36.01; P < 0.001) and procedure time (OR 1.01; 95% CI 1.01–1.01; P < 0.001) were independently associated with FTF. CONCLUSIONS: Factors associated with FTF in patients with Carpentier type I and II pathologies undergoing minimally invasive mitral valve repair are a New York Heart Association classification III–IV at baseline, pre-existing chronic kidney disease and coronary artery disease. Postoperative bleeding requiring rethoracotomy and procedure time were also identified as important factors associated with failed FT.

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The use of a telemanipulator requires special training and surgical performance is associated with a learning curve. The aim of this study was to demonstrate the potential value of Haptic-Visual over Visual-Only passive Training in telemanipulator-assisted surgery. Two telemanipulator consoles (da Vinci, Intuitive Surgical) were linked through an Application Programer's Interface allowing the applicant at the training console to register the position and passively follow the motions of the instructor's master telemanipulators (MTMs) at the master console (Haptic-Visual Learning group, HVL). The applicant could not actively interfere with the MTM movements. Both the trainee and the instructor shared the same 3-dimensional vision. Alternatively, subjects received only standard visual training without touching the MTMs (Visual-Only Learning group, VL). A standardized demonstration of tasks and the system was given for both groups. Participants (n=20) without previous experience with telemanipulation performed a set of various tasks in a randomized order. Study end points were time and accuracy required to perform the different task. The first task, with moving items to appropriate locations, showed differences in time to perform the task [mean: 4:06 min (HVL) vs. 5:16 min (VL) (P=0.2)] and accuracy differed among groups [mean number of errors 1.7 (VL) vs. 1.3 (HVL) P=0.38]. With more challenging tasks [cut out round figures (cut) and performing double dot suture lines (sti)] the number of errors was less in the HVL group [mean: 1.1 errors (cut) (P=0.05) and 1.8 errors (sti) (P=0.26)] compared with the VL group [mean: 1.8 errors (cut) and 2.3 errors (sti)]. In addition, the time to perform the tasks decreased in the HVL group with mean: 5.42 minutes (cut) (P=0.26) and 9.41 minutes (sti) (P=0.36) compared with the VL group with mean: 7.09 minutes (cut) and 11.43 minutes (sti). This study demonstrated the impact of haptic-visual passive learning in telemanipulator-assisted surgery which may alter the training for telemanipulator-assisted endoscopic procedures.