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Saqib Masroor

Publications and source records attributed to Saqib Masroor.

11 recordsLinked to original sources
PubMed2005

Robotic mitral valve annuloplasty with double-arm nitinol U-clips.

PURPOSE: Robotic mitral valve repair increases precision however operative times are longer. Prior studies have indicated that robotic knot tying is time consuming and it is without potential room for improvement. We therefore investigated tissue approximation devices that may shorten operative times. DESCRIPTION: A 67-year-old female was approached through a right mini-thoracotomy with the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Using 12 nitinol U-clips (Coalescent Surgical, Sunnyvale, CA) an annuloplasty band was placed under robotic guidance. Clip placement and deployment times were recorded and statistical comparisons were assessed to prior suture annuloplasties. EVALUATION: Clip placement time was 1.3 +/- 0.9 (minutes +/- standard deviation), statistical comparison with first, most recent, and all prior suture annuloplasties proving no significance. Clip deployment time was 0.5 +/- 0.2, whereas knot-tying times and respective statistical comparison for first, most recent, and all prior suture annuloplasties were 2.0 +/- 0.7 (p = 0.003), 1.2 +/- 0.4 (p = 0.0004), and 1.6 +/- 0.6 (p < 0.00001). Follow-up echocardiography performed postoperatively, at 3 months, and at 9 months revealed valvular structural integrity with only minimal mitral regurgitation. CONCLUSIONS: U-clips considerably reduce time for annuloplasty over conventional suture and may help reduce operative times as well.

Aged↗
PubMed2005

Combining robotic mitral valve repair and microwave atrial fibrillation ablation: techniques and initial results.

BACKGROUND: Left atrial microwave ablation for atrial fibrillation has become popular for isolating autonomous atrial foci. Previously, mitral valve repairs (MVP) with atrial fibrillation ablation have been performed through sternotomy. We present a technique that combines robotic MVP with left atrial fibrillation ablation. METHODS: Through a 4-cm right minithoracotomy and using cardiopulmonary bypass, the transverse and oblique sinuses are accessed. A Flex-10 microwave catheter is passed around the pulmonary veins, and after weaning from cardiopulmonary bypass, peripulmonary vein microwave ablations are performed. After cardioplegic arrest, the da Vinci system is used to manipulate the catheter to create endocardial lesions around the left atrial appendage. Another endocardial lesion is made connecting the pulmonary venous line with the mitral annulus near P3. The left atrial appendage is closed, and the MVP performed robotically. Data are expressed as mean +/- standard deviation. RESULTS: Sixteen patients underwent this combined procedure, with 80% returning to a normal sinus rhythm at 6 weeks and 73% remaining in normal sinus rhythm at 6 months. Only 1 patient was in atrial fibrillation at 6 months. The ablation procedure added 42 +/- 16.1 minutes to a robotic MVP. The average length of hospital stay was 6.3 +/- 2.2 days, 1.3 days longer than the mean of the prior 50 consecutive robotic MVP patients without a concomitant ablation. CONCLUSIONS: Robotic microwave ablation during robotic MVP is a safe, effective way to resolve atrial fibrillation. These methods offer a promising prelude to the combined totally endoscopic treatment of atrial arrhythmias and mitral insufficiency.

Aged↗
PubMed2004

Endoventricular pocket repair of type I myocardial rupture after mitral valve replacement: a new technique using pericardial patch, Teflon felt, and BioGlue.

Left ventricular (LV) rupture is an infrequent but potentially lethal complication of mitral valve replacement and repair. We report the case of an 82-year-old man who underwent mitral valve replacement and the repair of an atrial septal defect. Both valve leaflets were excised and the annulus was extensively decalcified, followed by the implantation of a bioprosthetic valve. LV rupture was diagnosed after weaning from cardiopulmonary bypass (CPB). CPB was resumed and the bioprosthetic valve was removed. The patient then underwent a unique repair using a pericardial patch, Teflon felt (Meadox Medical Inc, Oakland, NJ), and BioGlue (CryoLife Inc, Kennesaw, GA). A second valve was implanted with a successful outcome.

Aged↗
PubMed2004

Initial experience with sutureless proximal anastomoses performed with a mechanical connector leading to clampless off-pump coronary artery bypass surgery.

BACKGROUND: We report our early experience with the Symmetry Aortic Connector (St. Jude Medical, St. Paul, MN) used for sutureless proximal aortosaphenous vein graft anastomoses without any cross clamp during coronary bypass procedures. METHODS: Between November 2001 and August 2002, 206 saphenous vein to aorta proximal anastomoses were created in 132 patients using the Symmetry device. All procedures were performed as part of off-pump coronary artery bypass surgery without any aortic clamping. Intraoperative variables and postoperative data were collected and analyzed retrospectively. RESULTS: All 206 anastomoses (100%) were successfully completed with the connector. Severe atherosclerotic disease of the aorta was documented in 16 patients (12%). Four anastomoses (2%) required additional suture placement. Predeployment problems occurred with 3 grafts (2.5%) during loading of the connector. Average number of distal bypasses was 3.2 per patient. One patient (0.7%) required reoperation for bleeding from a proximal anastomosis. Six patients (4.5%) had perioperative myocardial infarction documented by electrocardiographic changes. Thirty-day operative mortality was 3% (4 patients). Intraoperative transit time flow measurement was performed in all cases (100%). Postoperative angiography in 43 patients at a median 3 months postoperatively revealed occlusion of 9 of the 81 saphenous vein grafts (11%). CONCLUSIONS: The initial experience with a proximal saphenous vein graft to aorta anastomosis using the Symmetry connector demonstrates safety and ease of use. There is however some concern with early graft closure. A prospective randomized study is needed to clarify these concerns.

Aged↗
PubMed2004

Beating-heart valve surgery in patients with renal failure requiring hemodialysis.

BACKGROUND AND AIM OF THE STUDY: The safety and efficacy of beating-heart valve surgery as a myocardial protection strategy was evaluated in patients with renal failure requiring hemodialysis. METHODS: This was a retrospective review of nine patients (four males, five females; mean age 46.7 years; mean duration of hemodialysis 47 +/- 49 months) who underwent beating-heart valve surgery at the present authors' institution between April 2000 and September 2002. RESULTS: The mean cardiopulmonary bypass time was 77.2 +/- 8 min. Perioperatively, two patients died (one from sepsis; one from complication of anticoagulation). There were no deaths in the follow up since discharge, with average follow up 18.3 months (range: 9-27 months). Other complications included reintubation for <24 h (one case), AV graft thrombosis (one patient) and stroke (one patient, as mentioned above). There were no new cardiac (including arrhythmia and low cardiac output syndrome) or metabolic complications (including hyperkalemia and fluid overload). CONCLUSION: This is the first report of beating-heart valve surgery using simultaneous antegrade and retrograde perfusion with normothermic blood. Despite being small in size, the study demonstrated the safety of this approach in a high-risk population with renal failure requiring hemodialysis. The results suggested a low incidence of complications, and short ICU and hospital stays.

Adult↗
PubMed2002

How to start a beating heart coronary artery surgery program.

An important issue that is not addressed in the recent literature on beating heart coronary artery bypass surgery is the question of how to initiate a program in OPCAB in a center where conventional coronary artery surgery has been the routine. It is the aim of this article to describe what we consider to be safe steps for a conventional cardiac surgeon to take to ensure a successful initiation of OPCAB surgery in his or her institution. While modern OPCAB surgery has experienced major technical advances that have made the procedure more predictably successful than in previous years, these advances require the use of an array of new technology and skills. This article discusses some of the skills and devices, such as modern stabilizers, shunts, and blowers, that the beginning OPCAB surgery team will need to acquire and master when embarking on an OPCAB program. Initiation of an OPCAB program also requires that the entire surgery team believe in the efficacy of the procedure and approach it with enthusiasm. A team visit to a center that already performs OPCAB is an important element in initiating the new program. It is no longer necessary to learn the procedures by trial and error. Because it will occasionally be necessary to convert from OPCAB to conventional surgery, the team must be thoroughly familiar with both methods and should not be reluctant to rely on the heart-lung machine when the patient's safety requires it.

Anastomosis, Surgical↗
PubMedDate not supplied

Beating heart aortic valve replacement in a pregnant patient.

A 23-year-old woman with a history of previous bileaflet mechanical aortic valve replacement presented in acute heart failure at 27 weeks of gestation. Transthoracic echocardiography (TEE) demonstrated minimal leaflet excursion consistent with valve thrombosis. The patient underwent emergent surgery with normothermic cardiopulmonary bypass (CPB), and beating-heart technique for valve replacement. This novel strategy for aortic valve replacement is being presented as being particularly useful in pregnant patients whose fetuses are at risks of hypothermia, hemodilution, and hyperkalemia during CPB.

Adult↗
PubMedDate not supplied

Redo-OPCAB via left thoracotomy using symmetry aortic connector system: a report of two cases.

Left thoracotomy is an established approach for redo coronary artery bypass grafting (CABG). This approach has also been successfully used in off-pump coronary artery bypass (OPCAB). Traditionally, the grafts have been anastomosed proximally to the descending thoracic aorta or the left subclavian artery. Recently, proximal connectors have been introduced by various manufacturers for use on ascending aorta during primary CABG and OPCAB. One such device is the Symmetry aortic connector system (St. Jude Medical, Minneapolis, MN). These devices have obviated the need for partial occluding clamps for the construction of the proximal anastomoses and hence are extremely useful when the aorta is heavily calcified. We used this device successfully in two patients undergoing redo-OPCAB, where the proximal anastomosis was constructed on the descending aorta. In so doing, we also used the shortest possible length of vein graft since the descending aorta at that level was much closer than the left subclavian artery. This can be an additional factor in redo-operations where the availability of vein can be an issue.

Aged↗
PubMedDate not supplied

Off-pump coronary artery grafting in patients with left main coronary artery disease.

BACKGROUND: Left main coronary artery disease (LMCD) is considered a relative contraindication to off-pump coronary artery bypass (OPCAB) grafting. This study evaluates the safety and feasibility of OPCAB in these patients compared to an on-pump group (cardiopulmonary bypass, CPB) with LMCD. METHODS: Between January 2000 and July 2002, 95 patients with left main coronary artery stenosis >50% underwent coronary revascularization. Seventy-three unselected patients underwent OPCAB and 22 underwent revascularization using CPB. The techniques used for OPCAB included the use of deep traction sutures in the posterior pericardium and stabilizers to expose the distal coronary targets. Intraluminal coronary shunts were routinely used during construction of the anastomoses. Variables were analyzed using a Student's paired t-test with statistical significance defined as p < 0.05. RESULTS: The mean age in the OPCAB group was 59.9 years and the CPB group 61.8 years (p = 0.54). There were 56 males (77%) in the OPCAB and 18 (82%) in the CPB groups. Mean preoperative left ventricular ejection fraction (LVEF) was 40.3% in OPCAB and 47.3% in CPB (p = 0.015). Average number of grafts was 3.1 in OPCAB and 4.1 in CPB (p = 0.0038). There were no conversions to CPB in those patients initially chosen to undergo OPCAB. There were no early deaths in OPCAB. There was one death in CPB. Mean hospital length of stay was 6.9 days for OPCAB and 9.1 for CPB (p = 0.0159). CONCLUSIONS: Patients with LMCD can undergo OPCAB grafting safely and effectively despite reduced LVEF. LMCD should no longer be seen as a contraindication to perform OPCAB grafting.

Aged↗