Endoscopic micro-invasive cardiac surgery: State-of-the-art

Figures

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  Figure 1. Computed tomography-based simulation of a 25-mm Inspiris prosthesis (Edwards Lifesciences, CA, USA) inside an aortic annulus with effective diameter of 25.9 mm using 3mensio, before endoscopic aortic valve replacement. (a-d) Simulation with sewing cuff (+7 mm). (e-g) Simulation without cuff (−7 mm). (h) Intraoperative echocardiography measurement. This patient received a 25-mm Inspiris prosthesis during endoscopic aortic valve replacement.

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  Figure 2. The CarnaLife Holo System in use intraoperatively. (a) using Microsoft’s augmented reality headset Hololens 2, the surgeon can see in real space the 3D reconstruction of CT images in real space as a hologram, which can be manipulated with hand gestures without instruments and in a sterile way. (b) The hologram as visible from the point of view of the surgeon.

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  Figure 3. Endoscopic view of the aortic annulus after native aortic valve excision during an endoscopic aortic valve replacement surgery.

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  Figure 4. Automated suturing technology used for micro-invasive valve replacement procedures. Reprinted with permission from LSI Solutions Inc.

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  Figure 5. The RAM device being used to place an annular suture during a totally endoscopic mitral valve replacement surgery.

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  Figure 6. The Bonn-Maneuver: The first RAM® device being used as a forceps to expose the adjacent receded part of the annulus. The latter can then be placed in the jaw of the second RAM® device for suture placement.

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  Figure 7. AVR-Navigator™ system which consists of a soft three-lobed aortic root retractor and a delivery device.

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  Figure 8. AVR-Navigator™ aortic root retractor system in use during an endoscopic aortic valve replacement surgery. (a) Aortic root following the excision of the native aortic valve prior to the use of the aortic root retractor. (b) shows the location of the third fixating suture, placed at the commissure between the left coronary sinus and the coronary sinus at the sinotubular junction. (c) The RAM® device being used to place the first annular suture in combination with the aortic root retractor.

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  Figure 9. The SOMOHA retractor being used in an endoscopic micro-invasive surgery, (a, b) show the SOMOHA retractor employed in an endoscopic aortic valve surgery both before deployment in a “rolled” state and after deployment and placement of an annular suture, respectively. (c) An endoscopic septal myectomy performed while using the SOMOHA retractor for a better exposure of the septum.

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  Figure 10. Endoscopic harvesting of the RIMA. RIMA: Right internal mammary artery.