Commentary: You cannot fix what you cannot see Article Swipe
Christopher C. H. Cook
,
Lawrence M. Wei
,
Harold G. Roberts
,
Vinay Badhwar
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1016/j.xjtc.2020.06.036
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1016/j.xjtc.2020.06.036
Central MessageAs minimally invasive cardiac surgical platforms continue to expand, the most successful and reproducible will be those that afford the most optimal visualization.See Article page 47. As minimally invasive cardiac surgical platforms continue to expand, the most successful and reproducible will be those that afford the most optimal visualization. See Article page 47. In this issue of JTCVS Techniques, Fukumoto and colleagues1Fukumoto Y. Hosoba S. Goto Y. Ito T. Totally 3D-endoscopic path closure of aorto-right ventricular fistula.J Thorac Cardiovasc Surg Tech. 2020; 3: 47-49Google Scholar have reported a case of endoscopic repair of an aorta to right ventricular fistula arising from a right sinus of Valsalva (SoV) aneurysm. The authors are to be congratulated on the excellent visualization and technical success of the operation and for their expansion of their minimally invasive platform using endoscopic assistance via a right lateral thoracotomy approach.1Fukumoto Y. Hosoba S. Goto Y. Ito T. Totally 3D-endoscopic path closure of aorto-right ventricular fistula.J Thorac Cardiovasc Surg Tech. 2020; 3: 47-49Google Scholar The anatomic location of the fistula in their report is consistent with historical reports of the right SoV communicating most commonly with the right ventricle.1Fukumoto Y. Hosoba S. Goto Y. Ito T. Totally 3D-endoscopic path closure of aorto-right ventricular fistula.J Thorac Cardiovasc Surg Tech. 2020; 3: 47-49Google Scholar,2Meyer J. Wukasch D.C. Hallman G.L. Cooley D.A. Aneurysm and fistula of the sinus of Valsalva: clinical considerations and surgical treatment in 45 patients.Ann Thorac Surg. 1975; 19: 170-179Abstract Full Text PDF PubMed Scopus (62) Google Scholar In addition to the etiology presented, similar fistulas have occurred as a complication of transcatheter aortic valve replacement.3Konda M.K. Kalavakunta J.K. Pratt J.W. Martin D. Gupta V. Aorto-right ventricular fistula following percutaneous transcatheter aortic valve replacement: case report and literature review.Heart Views. 2017; 18: 133-136Crossref PubMed Google Scholar Although percutaneous closure of aortic root fistulas as a complication of transcatheter aortic valve replacement and SoV aneurysms have been attempted,4Damman P. de Jong K.H. de Geus K. de Winter R.J. Transcatheter closure of an iatrogenic aorta-right ventricular fistula after transfemoral aortic valve implantation.Eur Heart J Case Rep. 2017; 1: ytx019PubMed Google Scholar surgical repair will often be warranted. This is especially important for young and otherwise stable patients. Repair is dependent on excellent visualization of the aortic root and an intimate knowledge of the adjacent anatomic relationships. The principles of clear visualization apply to the platform of techniques used in minimally invasive aortic valve replacement (AVR), regardless of whether the operation is completed under direct vision via ministernotomy (MS) or right anterior thoracotomy (RAT). Miceli and colleagues5Miceli A. Murzi M. Gilmanov D. Fuga R. Ferrarini M. Solinas M. et al.Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy.J Thorac Cardiovasc Surg. 2014; 148: 133-137Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar have further demonstrated lower overall morbidity with RAT than with MS. A recent meta-analysis of 6 studies comparing the MS and RAT approaches found a reduced hospital length of stay for the RAT group but no difference in mortality.6Balmforth D. Harky A. Lall K. Uppal R. Is ministernotomy superior to right anterior minithoracotomy in minimally invasive aortic valve replacement?.Interact Cardiovasc Thorac Surg. 2017; 25: 818-821Crossref PubMed Scopus (13) Google Scholar Although the RAT and MS approaches are both reproducible approaches for AVR, RAT might often require transection of the second or third rib at the costochondral junction and division of the right internal mammary artery and vein to facilitate appropriate direct visual exposure. This could require rib fixation on closure. Minimally invasive approaches to the mitral valve (MV) are performed more laterally, usually in the fourth intercostal space and with the incision generally centered just anterior to the mid-axillary line. Exposure via this approach does not require rib transection. Minimally invasive MV surgery has often been facilitated by 3-dimensional endoscopic assistance, with or without robotic telemanipulation. Fukumoto and colleagues1Fukumoto Y. Hosoba S. Goto Y. Ito T. Totally 3D-endoscopic path closure of aorto-right ventricular fistula.J Thorac Cardiovasc Surg Tech. 2020; 3: 47-49Google Scholar have elegantly illustrated how this lateral approach can provide excellent visualization to clearly see the necessary pathology and the aortic valve using endoscopic assistance and shafted instruments. We have completed well over 500 robotic MV operations using the robotic platform. Building on that experience, we have now performed robotic-assisted AVR using exactly the same approach used for MV surgery, the only exception being that the fourth intercostal incision is oriented ∼1 to 2 cm more anteriorly for AVR. In our experience, the robotic platform provides superior optics and improved range of motion to clearly visualize pathology. As experience in minimally invasive cardiac surgery continues to increase, the types of cases that can be accomplished will certainly expand—as long as the visualization remains optimal for safety and efficacy. The excellent technical report by Fukumoto and colleagues1Fukumoto Y. Hosoba S. Goto Y. Ito T. Totally 3D-endoscopic path closure of aorto-right ventricular fistula.J Thorac Cardiovasc Surg Tech. 2020; 3: 47-49Google Scholar is further evidence of that premise. Totally 3D-endoscopic patch closure of aorto-right ventricular fistulaJTCVS TechniquesVol. 3PreviewAorto-right ventricular fistula (ARVF) is an extremely rare malformation that can lead to heart failure if left untreated. Therefore, surgical repair is recommended, but a suitable approach remains a matter of debate. Here we report a case of totally 3D endoscopic minimally invasive repair of AVRF. Full-Text PDF Open Access
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- Type
- editorial
- Language
- en
- Landing Page
- https://doi.org/10.1016/j.xjtc.2020.06.036
- http://www.jtcvstechniques.org/article/S2666250720303187/pdf
- OA Status
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Commentary: You cannot fix what you cannot seeWork title
- Type
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editorialOpenAlex work type
- Language
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enPrimary language
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2020Year of publication
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2020-06-24Full publication date if available
- Authors
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Christopher C. H. Cook, Lawrence M. Wei, Harold G. Roberts, Vinay BadhwarList of authors in order
- Landing page
-
https://doi.org/10.1016/j.xjtc.2020.06.036Publisher landing page
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https://www.jtcvstechniques.org/article/S2666250720303187/pdfDirect link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://www.jtcvstechniques.org/article/S2666250720303187/pdfDirect OA link when available
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Medicine, Fistula, Aneurysm, Ventricle, Sinus (botany), Surgery, Closure (psychology), Cardiology, Law, Biology, Genus, Botany, Political scienceTop concepts (fields/topics) attached by OpenAlex
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| abstract_inverted_index.this | 55, 621, 675 |
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| abstract_inverted_index.visual | 580 |
| abstract_inverted_index.Article | 24, 51 |
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| abstract_inverted_index.authors | 110 |
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| abstract_inverted_index.clearly | 683, 764 |
| abstract_inverted_index.closure | 73, 153, 201, 300, 330, 658, 816, 838 |
| abstract_inverted_index.debate. | 875 |
| abstract_inverted_index.exactly | 722 |
| abstract_inverted_index.expand, | 9, 35 |
| abstract_inverted_index.failure | 858 |
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| abstract_inverted_index.reduced | 494 |
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| abstract_inverted_index.without | 642 |
| abstract_inverted_index.Although | 298, 539 |
| abstract_inverted_index.Aneurysm | 221 |
| abstract_inverted_index.Building | 711 |
| abstract_inverted_index.Exposure | 619 |
| abstract_inverted_index.Fukumoto | 60, 645, 803 |
| abstract_inverted_index.Gilmanov | 429 |
| abstract_inverted_index.Valsalva | 106 |
| abstract_inverted_index.addition | 251 |
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| abstract_inverted_index.closure. | 588 |
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| abstract_inverted_index.oriented | 740 |
| abstract_inverted_index.outcomes | 450 |
| abstract_inverted_index.platform | 133, 394, 754 |
| abstract_inverted_index.premise. | 834 |
| abstract_inverted_index.provides | 755 |
| abstract_inverted_index.reported | 87 |
| abstract_inverted_index.suitable | 869 |
| abstract_inverted_index.superior | 517, 756 |
| abstract_inverted_index.surgery, | 729 |
| abstract_inverted_index.surgical | 5, 31, 232, 351, 863 |
| abstract_inverted_index.Ferrarini | 433 |
| abstract_inverted_index.Full-Text | 890 |
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| abstract_inverted_index.aneurysms | 315 |
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| abstract_inverted_index.comparing | 486 |
| abstract_inverted_index.completed | 411, 700 |
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| abstract_inverted_index.elegantly | 672 |
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| abstract_inverted_index.important | 360 |
| abstract_inverted_index.increase, | 776 |
| abstract_inverted_index.knowledge | 380 |
| abstract_inverted_index.minimally | 2, 28, 131, 399, 523, 770, 885 |
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| abstract_inverted_index.necessary | 686 |
| abstract_inverted_index.operation | 124, 409 |
| abstract_inverted_index.otherwise | 364 |
| abstract_inverted_index.pathology | 687 |
| abstract_inverted_index.patients. | 366 |
| abstract_inverted_index.performed | 598, 718 |
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| abstract_inverted_index.platforms | 6, 32 |
| abstract_inverted_index.technical | 120, 800 |
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| abstract_inverted_index.visualize | 765 |
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| abstract_inverted_index.literature | 289 |
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| abstract_inverted_index.pathology. | 766 |
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| abstract_inverted_index.successful | 12, 38 |
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| abstract_inverted_index.Kalavakunta | 269 |
| abstract_inverted_index.Techniques, | 59 |
| abstract_inverted_index.aorta-right | 334 |
| abstract_inverted_index.aorto-right | 75, 155, 203, 660, 818, 840 |
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| abstract_inverted_index.assistance, | 639 |
| abstract_inverted_index.expand—as | 787 |
| abstract_inverted_index.experience, | 714, 751 |
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| abstract_inverted_index.illustrated | 673 |
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| abstract_inverted_index.transection. | 627 |
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| abstract_inverted_index.ytx019PubMed | 348 |
| abstract_inverted_index.3-dimensional | 637 |
| abstract_inverted_index.3D-endoscopic | 71, 151, 199, 656, 814, 836 |
| abstract_inverted_index.Transcatheter | 329 |
| abstract_inverted_index.communicating | 184 |
| abstract_inverted_index.congratulated | 114 |
| abstract_inverted_index.costochondral | 564 |
| abstract_inverted_index.meta-analysis | 482 |
| abstract_inverted_index.transcatheter | 264, 282, 309 |
| abstract_inverted_index.visualization | 118, 372, 390, 681, 791 |
| abstract_inverted_index.Scholar,2Meyer | 213 |
| abstract_inverted_index.TechniquesVol. | 843 |
| abstract_inverted_index.considerations | 230 |
| abstract_inverted_index.ministernotomy | 416, 516 |
| abstract_inverted_index.relationships. | 385 |
| abstract_inverted_index.visualization. | 49 |
| abstract_inverted_index.133-136Crossref | 294 |
| abstract_inverted_index.133-137Abstract | 458 |
| abstract_inverted_index.170-179Abstract | 241 |
| abstract_inverted_index.818-821Crossref | 533 |
| abstract_inverted_index.minithoracotomy | 445, 521 |
| abstract_inverted_index.implantation.Eur | 341 |
| abstract_inverted_index.ministernotomy.J | 452 |
| abstract_inverted_index.robotic-assisted | 719 |
| abstract_inverted_index.attempted,4Damman | 318 |
| abstract_inverted_index.colleagues5Miceli | 425 |
| abstract_inverted_index.telemanipulation. | 644 |
| abstract_inverted_index.visualization.See | 23 |
| abstract_inverted_index.approach.1Fukumoto | 142 |
| abstract_inverted_index.replacement.3Konda | 267 |
| abstract_inverted_index.3PreviewAorto-right | 844 |
| abstract_inverted_index.colleagues1Fukumoto | 62, 647, 805 |
| abstract_inverted_index.ventricle.1Fukumoto | 190 |
| abstract_inverted_index.mortality.6Balmforth | 507 |
| abstract_inverted_index.replacement?.Interact | 527 |
| cited_by_percentile_year | |
| corresponding_author_ids | https://openalex.org/A5036907811 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 4 |
| corresponding_institution_ids | https://openalex.org/I12097938 |
| citation_normalized_percentile.value | 0.11162561 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |