The minimally invasive approach is the direction of cardiac surgery.With the development of telemanipulation and computer technology,the minimally robotic surgery has become reality.As the one of the most minimally invasive cardiac surgery,the robotic surgical system provides cardiac surgeons with less invasive manner and dexterity manipulation.Robotic cardiac surgery is an evolutionary process and has resulted in a substantial increased attention to surgeons and patients.This review is to introduce the recent clinical application of robotic technology in cardiac surgery.

Objective To investigate the effect of non-restrictive external stent on both cell proliferation of rabbit vein grafts and prevention from hyperplasia of the grafts' neointima. Methods 36 New Zealand white rabbits were randomly divided into two groups, each animal was subjected to a reversed autologous venous graft between external jugular vein and common carotid artery. In stenting group (group S), the vein grafts were surrounded by a 6 mm in diameter non-restrictive stent, and in non-stenting group (group NS), there is no stent to support the vein grafts. The grafts were harvested 1 week (1W), 2 weeks (2W) and 4 weeks (4W) after surgery, respectively. The sections were stained with hematoxylin and eosin stain, ?-smooth muscle actin (?-SMA) and proliferating cell nuclear antigen (PCNA) immunocytochemistry stain. PCNA index was calculated in intima, media and adventitia, respectively. Results (1) HE staining: From 1W to 4W, the hyperplasia of intima and media appeared gradually in both group S and group NS, nevertheless such hyperplasia in group S was lessintense than in group NS. (2) ?-SMA staining: Almost all cells in media were positive, but few cells were positive in intima of both groups at 1W; the thickness of intima of both groups increased gradually, and almost all cells except endothelial cells were positive in intima in both groups, though the thickness of intima of group S was smaller than in group NS at 2W and 4W. (3) PCNA index: the index of intima in both two groups peaked at 2W, and the index of intima in group S was less than in group NS at 2W and 4W, P

0.05; at 14 d,28 d, the thickness and area of the intiam in group S were smaller than those in group NS,P

Objective To compare the economic outcome between on-pump and off-pump coronary artery bypass grafting (CABG). Methods Six hundred seventy-nine patients were divided into on-pump and off-pump groups. Twelve variables with respect to costs were obtained for each group during hospital stay. Results There was no significant difference in total mean cost between two groups. For off-pump patient, the costs of medication, operation, blood transfusion, bed occupancy, and nursery were significantly less than those of on-pump CABG surgery was (P0.05). Conclusion Costs of OPCAB are not significantly lower than on-pump CABG due to higher material costs.

Objective To study the clinical characteristics and surgical treatment of left ventricular outflow tract obstruction (LVOTO) caused by congenital accessory mitral valve (AMV) tissue. Methods Two cases were treated in our department. Pre-operatively, case 1 was diagnosed as congenital heart disease with severe LVOTO and anterior mitral valve cleft; case 2 was diagnosed as congenital atrial septal defect combined with AMV and mild LVOTO as well as mild mitral valve regurgitation. Both patients were operated on under CPB. In case 1, LVOTO was caused by AMV which belonged to Type I (fixed type). In case 2, the AMV was type II (mobile type). Results Both AMV tissues were resected through atrial septum, and combined cardiac disorders were repaired simultaneously. The operations were successful and the patients were discharged with good results. Echocardiography revealed that the LVOTO almost disappeared. Conclusions LVOTO caused by AMV is a rare congenital heart disorder. AMV may be removed with acceptable postoperative outcome. Prophylactic removal of AMV tissue should not be attempted in patients with no or mild LVOTO and no other associated heart defects. These patients should be followed and observed periodically by Doppler echocardiography to identify any progression in LVOTO.

cases of coronary artery bypass grafting (CABG) were analyzed retrospectively. They were divided into four groups. In group 1 ( n =63,1985～1996), group 2 ( n =160, 1997～1999), and group 3 ( n =209, 2000～2002), CABG was performed with cardiopulmonary bypass (CPB). In group 4 ( n =291, 2000～2002) CABG was performed with off pump (OP). The durations of CPB and aortic cross clamp (ACC), temperature, hemodilusion, duration of using ventilator postoperatively, and ICU stay days were analyzed and compared. The patients in the groups 3 and 4 were older than those of the group 1, but younger than group 2. Pre operative supersonic EF value was lower in patients in the group 3 compared with group 2. A tendency of shortening of CPB time and ACC time, raising of temperature, lowering of hemodilusion, and shortening of ventilator time and ICU stay days could be discerned from group 1 down to group 4 ( P

70 years, history of stroke, and a tear of the pleura. Conclusions The incidence of AF in CABG and off-pump CABG were almost similar. Old age of the patient was the pathological basis for developing AF, and the history of stroke and a tear of the pleura were the predisposing factors.

Objective To summarize the experience in diagnosis and surgical treatment of double-chambered right ventricle (DCRV). Methods From 1990 to 2001, 95 patients with DCRV received surgical correction, including 56 males and 39 females, with an age ranging from 1 to 48. 82 cases had other cardiac abnormalities, 56 of whom had ventricular septal defect (VSD). Right atrium incision was made in 8 patients, right ventricular infundibular incision in 30, and both right atriotomy and ventriculotomy in 57. Results Muscular ring was found in 61 patients, and muscular shelf in 34. No death occurred. Preoperatively, 15 patients and 3 patients were misdiagnosed by echocardiography as VSD and pulmonary stenosis, respectively. The diagnosis was corrected during operation. Conclusions DCRV was often found to be complicated with other cardiac disorders. Echocardiography was the main diagnotic method, but the misdiagnosis was not uncommon. So it was very important to make surgical exploration, especially on tricuspid valve and pulmonary valve during intraventricular operations. Right ventricular infundibular incision was convenient and dependable.

Objective To introduce the strategy of perioperative blood glucose control and the early outcome in diabetic and non-diabetic patients undergone coronary artery bypass grafting (CABG). Methods A total of 1019 CABG were performed and the patients were divided into diabetic and non-diabetic groups (n=211, 808, respectively). The demography was comparable between the two groups with the exception that the percentage of preoperative myocardial infarction was significantly higher in diabetic group than that in non-diabetic group. Off-pump and conventional CABG were routinely performed and the left internal mammary artery (IMA) and great saphenous vein (GSV) were used as conduit. Perioperative blood glucose was controlled according to the close supervision. The aim of preoperative 6mmol/L and postoperative 8mmol/L was achieved by means of oral medication or subcutaneous injection of insulin, which was complimented by continuous pump infusion of regular insulin to optimize the glucose level. Results 99.2% patients were discharged. The overall perioperative mortality was 0.8% and the percentage was 1.4% and 0.6% respectively in diabetic and non-diabetic group with significant difference(P0.05), respectively. Cerebral infarction occurred in 1.4% diabetic patients and in 0.5% non-diabetic patients(P

Objective To summarize the clinical experience of coronary angiography before coronary artery grafting (CABG) with concomitant valvular surgery in patients with valvlar disease. Methods From April 2000 to May 2005, two hundred and eleven patients over 50 years old (mean age 60 3.5) with valvlar diseases were studied retrospectively. Coronary angiography was utilized for patients who were found to have risk factors for atherosclerosis. Coronary stenosis over 50% of its calibre was considered positive, and 75% stenosis (including LMCA stenosis more than 50%) was used as the indication for coronary artery bypass surgery. Results Coronary angiography was employed in 128 patients and 30 cases (23.4%) had coronary artery stenosis exceeding 50%. CABG was concomitantly performed during cardiac valvular surgery in 24 patients. In-hospital mortality in patients with valve surgery alone was 0.5%, which was significantly lower compared with patients with valve surgery combined with CABG group (4.2%)(P