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The Future of Minimally Invasive Cardiac Surgery

The Future of Minimally Invasive Cardiac Surgery. Marco A. Zenati, M.D. Professor of Surgery and Bioengineering University of Pittsburgh School of Medicine. Hans Jacobeus Pioneer of Thoracoscopy (Stockholm 1910). Modified Cystoscope.

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The Future of Minimally Invasive Cardiac Surgery

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  1. The Future of Minimally Invasive Cardiac Surgery Marco A. Zenati, M.D. Professor of Surgery and Bioengineering University of Pittsburgh School of Medicine

  2. Hans JacobeusPioneer of Thoracoscopy (Stockholm 1910) Modified Cystoscope Jacobeus HC. The Cauterization of Adhesions in Pneumothorax Treatment of Tuberculosis. Surg Gynecol Obster 1921:32:493-500 (40 patients)

  3. Thoracic Endoscopy Pioneers in Pittsburgh1993 - Luketich Landreneau

  4. From MIDCAB to TECAB

  5. Dexterity Enhancement

  6. “Intuitive” Surgery:Can You Beat a Fifth Grader?

  7. Robotic Surgery in Pittsburgh Intuitive Surgical’s DaVinci 2004- Computer Motion’s ZEUS 1999-2002

  8. April 5th, 2001 University of Pittsburgh Medical CenterFirst U.S. Robotic Off-Pump CABG Patient: 63 yo JAC Cardiac Surgeon: Marco A. Zenati, M.D. Day of discharge home: April 8th, 2001 POD#2

  9. Level 4 MIS for MVR

  10. “Ideal”Minimally Invasive Surgical Procedure • Single Port • Access ANYWHERE • Local vs General Anesthesia • No need for unnecessary invasion of pleural spaces • Minimize pain NEJM 2006;354:20

  11. MIS Tools Constrained to Pivot at the Body Entry Point

  12. HEARTLANDER The New York Times May 2007

  13. HeartLander

  14. Bilateral VATS for Pulmonary Vein Isolation in AF

  15. SUBXIPHOID ACCESS

  16. Patient-Specific Strategy for AF

  17. Ganglionated Plexi Armour Anat Record 1997

  18. Rigid Endoscope and Instrument Arm Shaft • Unable to navigate complex 3D geometry spaces (e.g. pericardial space)

  19. Ann Thorac Surg 2007

  20. RAA LAA Entry point: Subxiphoid Through Transverse Sinus

  21. RSS Design -Current Prototype-

  22. HYBRID INTERVENTIONAL SUITE Continuous EKG and hemodynamic monitoring Fluoroscopy Direct Endoscopic SVP Visualization NAVx 3D Imaging StJude Med Cardiac Surgeon Cardiac Electrophysiologist

  23. Subxiphoid Approach

  24. Myocor COAPSYS

  25. Common Lesion Sets Employed in AF Ablation

  26. Cox-Maze IV

  27. Future Clinical “Battlefields” • Heart Failure • Ischemic Mitral Regurgitation • Prevention of Remodeling after MI • Atrial Fibrillation

  28. Closed Chest Epicardial Ablation Pathway Ablation procedure • 8 Fr. catheter with an irrigated radiofrequency tip (Biosense Webster) • 60ºC, 40 watt, 15 seconds × several times

  29. Subxiphoid Videopericardioscopy for CRT Lead Zenati et al. Circulation 2002

  30. Epicardial Lead Placement for CRTwith DaVinci Robotic System

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