Background: European surgeons were the first worldwide to use robotic techniques in cardiac surgery and major steps in procedure development were taken in Europe. After a hype in the early 2000s case numbers decreased but due to technological improvements renewed interest can be noted. We assessed the current activities and outcomes in robotically assisted cardiac surgery on the European continent.Methods: Data were collected in an international anonymized registry of 26 European centers with a robotic cardiac surgery program.Results: During a 4-year period (2016–2019), 2,563 procedures were carried out [30.0% female, 58.5 (15.4) years old, EuroSCORE II 1.56 (1.74)], including robotically assisted coronary bypass grafting (n = 1266, 49.4%), robotic mitral or tricuspid valve surgery (n = 945, 36.9%), isolated atrial septal defect closure (n = 225, 8.8%), left atrial myxoma resection (n = 54, 2.1%), and other procedures (n = 73, 2.8%). The number of procedures doubled during the study period (from n = 435 in 2016 to n = 923 in 2019). The mean cardiopulmonary bypass time in pump assisted cases was 148.6 (63.5) min and the myocardial ischemic time was 88.7 (46.1) min. Conversion to larger thoracic incisions was required in 56 cases (2.2%). Perioperative rates of revision for bleeding, stroke, and mortality were 56 (2.2%), 6 (0.2 %), and 27 (1.1%), respectively. Median postoperative hospital length of stay was 6.6 (6.6) days.Conclusion: Robotic cardiac surgery case numbers in Europe are growing fast, including a large spectrum of procedures. Conversion rates are low and clinical outcomes are favorable, indicating safe conduct of these high-tech minimally invasive procedures.

Cardiac arrhythmias are a major factor in the occurrence of morbidity and sudden death in patients with cardiovascular disease. Disturbances of Ca²⁺ homeostasis in the heart contribute to the initiation and maintenance of cardiac arrhythmias. Extrasystolic increases in intracellular Ca²⁺ lead to delayed afterdepolarizations and triggered activity, which can result in heart rhythm abnormalities. It is being suggested that the Ca²⁺-activated nonselective cation channel TRPM4 is involved in the aetiology of triggered activity, but the exact contribution and in vivo significance are still unclear. In vitro electrophysiological and calcium imaging technique as well as in vivo intracardiac and telemetric electrocardiogram measurements in physiological and pathophysiological conditions were performed. In two distinct Ca²⁺-dependent proarrhythmic models, freely moving Trpm4^−/− mice displayed a reduced burden of cardiac arrhythmias. Looking further into the specific contribution of TRPM4 to the cellular mechanism of arrhythmias, TRPM4 was found to contribute to a long-lasting Ca²⁺ overload-induced background current, thereby regulating cell excitability in Ca²⁺ overload conditions. To expand these results, a compound screening revealed meclofenamate as a potent antagonist of TRPM4. In line with the findings from Trpm4^−/− mice, 10 µM meclofenamate inhibited the Ca²⁺ overload-induced background current in ventricular cardiomyocytes and 15 mg/kg meclofenamate suppressed catecholaminergic polymorphic ventricular tachycardia-associated arrhythmias in a TRPM4-dependent manner. The presented data establish that TRPM4 represents a novel target in the prevention and treatment of Ca²⁺-dependent triggered arrhythmias. Proposed mechanism of the specific contribution of TRPM4 to the cellular mechanism of Ca²⁺-dependent triggered arrhythmias associated with, for example, acute ischaemia or catecholaminergic polymorphic ventricular tachycardia (CPVT). Typically for these conditions, aberrant Ca²⁺ release events induce a transient inward current (I_ti) on top of a background current (I_background) in ventricular myocytes, which underlies delayed afterdepolarizations that trigger ectopic action potentials when the threshold potential is reached. The TRPM4 specifically contributes to the Ca²⁺ overload-induced background current that augments cellular excitability, and inhibition of TRPM4 with meclofenamate efficiently suppresses CPVT-associated arrhythmias in living mice. AP, action potential; CPVT, catecholaminergic polymorphic ventricular tachycardia; DAD, delayed afterdepolarization; V_m, membrane potential; V_threshold, threshold potential.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Wearable technology is finding its way in clinical practices. Physical Activity (PA) describes patient’s functional status after cardiac surgery and in remote monitoring by use of PA trackers. Objective: The aim of this work is to assess the usability of a wearable fitness tracker, to monitor patients who underwent coronary artery bypass surgery, by either the conventional Off-Pump procedure (OPCAB) or robotically assisted CABG (RA-MIDCAB). We hypothesized a faster recovery of functional status after RA-MIDCAB in the first weeks after discharge. Methods: Patients undergoing RA-MIDCAB or OPCAB were included. Each patient received a Fitbit Charge Heart Rate PA tracker (Fitbit Inc., San Francisco, CA, USA) following discharge. Rehabilitation progress was assessed by measuring the number of steps and physical activity level (PAL) daily. PAL was calculated as energy expenditure divided by basic metabolic rate. Results: 10 RA-MIDCAB patients with a median age of 68 (IQR: [60;76]) and 12 OPCAB patients with a median age of 69 (IQR: [65;76]) were included. Baseline characteristics were comparable except for BMI (RA-MIDCAB: 26 Kg/m² [24;27] versus OPCAB: 29 Kg/m² [27;31]; P<0.001, respectively). Intubation time (P<0.05) was significantly lower in the RA-MIDCAB group. A clear trend, although not statistically significant, was observed towards a higher number of steps in RA-MIDCAB patients in the first week following discharge. Conclusions: Wearable PA trackers can describe functional status in a cardiac rehabilitation setting after surgery. RA-MIDCAB patients have an advantage in recovery in the first weeks of revalidation reflected by the number of steps and PAL, measured by the Fitbit Charge HR, compared to OPCAB patients. However, unsupervised assessment of daily PA varied greatly and this could involve consequences for the use of these trackers as research tools. Clinical Trial: S59757

Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis Jef Van den Eynde, Hannah Vaesen Bentein, Tom Decaluwé, Herbert De Praetere, MaryAnn C. Wertan, Francis P. Sutter, Husam H. Balkhy, Wouter Oosterlinck

We have characterized both acute and long-term vascular and metabolic effects of unilateral common carotid artery occlusion in mice by in vivo magnetic resonance imaging and positron emission tomography. This common carotid artery occlusion model induces chronic cerebral hypoperfusion and is therefore relevant to both preclinical stroke studies, where it serves as a control condition for a commonly used mouse model of ischemic stroke, and neurodegeneration, as chronic hypoperfusion is causative to cognitive decline. By using perfusion magnetic resonance imaging, we demonstrate that under isoflurane anesthesia, cerebral perfusion levels recover gradually over one month. This recovery is paralleled by an increase in lumen diameter and altered tortuosity of the contralateral internal carotid artery at one year post-ligation as derived from magnetic resonance angiography data. Under urethane/α-chloralose anesthesia, no acute perfusion differences are observed, but the vascular response capacity to hypercapnia is found to be compromised. These hemispheric perfusion alterations are confirmed by water [¹⁵O]-H₂O positron emission tomography. Glucose metabolism ([¹⁸F]-FDG positron emission tomography) or white matter organization (diffusion-weighted magnetic resonance imaging) did not show any significant alterations. In conclusion, permanent unilateral common carotid artery occlusion results in acute and long-term vascular remodeling, which may have immediate consequences for animal models of stroke but also vascular dementia.