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Objectives: Robotic-enhanced minimally invasive direct coronary artery bypass grafting surgery (RE-MIDCAB) is based on the use of a robotic console and instrumentation for the dissection of the left internal thoracic artery (LITA). The LITA to left anterior descending (LAD) artery anastomosis is subsequently constructed through a mini thoracotomy. The purpose of this study is to present our experience of RE-MIDCAB outcomes in elderly patients., Methods: From 2002 until 2015, 44 octogenarians (the mean age of 82.9 years) underwent RE-MIDCAB. The mean logistic EuroSCORE was 9.2. The majority of the patients were male with a medical history of hypertension, dyslipidaemia and previous coronary interventions. Of these patients 25% underwent RE-MIDCAB combined with percutaneous coronary intervention (PCI) for the treatment of multi-vessel disease (hybrid revascularization)., Results: All RE-MIDCABs and combined 'hybrid' PCI procedures were successfully completed. The mean intensive care unit (ICU) and hospital stay were 1.6 days and 10.9 days, respectively. There was 1 in-hospital mortality (2.3%). After an average follow-up period of 29.2 months, 5 patients required repeat revascularization procedures (9.1%). Mortality on follow-up was estimated at 25.6%., Conclusions: Our report suggests that considering the age and frailty of the octogenarian population, RE-MIDCAB is a feasible and safe procedure which is associated with acceptable mid-term results., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

This report describes an approach for the treatment of high-risk native mitral valve stenosis. It incorporates the deployment of a transcatheter valve in the mitral position under full endoscopic vision, combined with endoscopic mitral repair techniques that secure valve positioning and reduce the risk of paravalvular leak. This approach could be used as a rescue procedure in centres with experience in transcatheter and endoscopic valve techniques., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objectives: This study presents the first report on short- and long-term outcomes in redo-port access surgery after previous port access surgery (redo-PAS-PAS) for new or recurrent mitral valve (MV) and tricuspid valve (TV) disease., Methods: Our current surgical team performed redo-PAS-PAS in 26 consecutive patients who had previous port access surgery (mean age 65.8 ± 13.3 years, 46.2% female, 42.3% older than 70 years, mean logistical EuroSCORE 22.5 ± 21.6%) between 1 February 1997 and 30 June 2014. Surgical indications included among others MV prosthesis dysfunction (n = 8, 30.8%), endocarditis (n = 10, 38.5%) and TV dysfunction (n = 3, 11.5%). The mean time interval between primary PAS and redo-PAS-PAS was 70.32 ± 57.4 months., Results: Redo-PAS-PAS procedures included MV replacement (n = 19, 73.1%), MV repair (n = 5, 19.2%), and TV repair (n = 2, 7.7%). Sternotomy conversion was required in 5 patients (19.2%), of which 4 (15.4%) were early conversions due to lung adhesion and 1 (3.8%) due to a late intraoperative complication. The mean cardiopulmonary bypass and cross-clamp times were 163.3 ± 57.9 and 101.2 ± 43.8 min, respectively. Postoperative mechanical ventilation longer than 72 h was required in 4 patients (15.4%). In-hospital morbidities included hospital-acquired pneumonia (n = 3, 11.5%), postoperative air leaks (n = 2, 7.7%) and revision for bleeding (n = 1, 3.8%). The mean length of hospital stay was 16.1 days. Long-term clinical and echocardiographic follow-up were 48.3 ± 39.2 and 44.6 ± 32.9 months, respectively. The Kaplan-Meier analyses for survival and freedom from mitral and tricuspid valve reintervention (n = 26) at 5 years were 83.9 and 95.8%, respectively, with 91.3% of surviving patients classified as being NYHA II or less. Echocardiographic follow-up showed no residual mitral regurgitation more than grade I in all redo mitral valve repairs and no paravalvular leak post-valve replacement., Conclusions: Redo-PAS-PAS is our routine approach and we apply this strategy in the majority of patients who had previous port access surgery. The predicted procedure-related mortality, morbidities, patient satisfaction and long-term outcomes are favourable., (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)