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Robotic Assistance in Reoperative Cardiac Surgery: Feasibility and Early Outcomes
Husam H. Balkhy, Zewditu Asfaw, Brooke Wilkey, Mackenzie Reupert, Dorothy Krienbring, Susan Arnsdorf.
University of Chicago Medicine, Chicago, IL, USA.
OBJECTIVE: Robotic cardiac surgery is well established in the literature and can improve outcomes by eliminating the potential complications of sternotomy, decreasing hospital length of stay and improving recovery times. These benefits are enhanced in patients who have had previous cardiac surgical procedures by eliminating the added risk of redo sternotomy. We reviewed our robotic assisted reoperative cardiac surgical procedures
METHODS: We performed a retrospective chart review of our robotic redo cardiac surgical procedures from 2008 to 2015. The surgical approach was to introduce a 5mm scope into the appropriate pleural space away from previous incisions. A limited VATS dissection was then performed as necessary to create space for robotic camera and arms after which the robot was docked and the rest of the redo dissection carried out. Valve and intra-cardiac procedures were performed with peripheral cannulation and endo-balloon cardiac arrest. TECAB was performed on the beating heart with anastomotic devices.
RESULTS: From 2008 to 2015, 851 patients underwent robotic assisted cardiac surgery. Forty four patients had one or more previous cardiac surgical procedures. 40 patients had 1 previous cardiac surgical procedure and 4 patients had 2 previous cardiac surgeries. Demographics are shown in table 1.
Ten patients underwent robotic beating heart TECAB, 10 patients underwent epicardial LV lead placements, one patient underwent atrial myxoma removal, and 23 patients underwent valve procedures (15 Mitral valve, 5 combined MV/Tricuspid valve, and 3 Isolated TV).
Of the 20 MV procedures 14 were repairs and 6 were replacements, of the 8 TV procedures, 7 were repairs and one was a replacement. There were 8 concomitant Cryo-maze procedures for Atrial Fibrillation.
Median LOS was 4 days. One patient was converted to sternotomy. Peri-operative mortality was 2.3%
CONCLUSIONS: Robotic assisted re-operative cardiac surgery is feasible with excellent clinical outcomes. A large experience in robotic cardiac surgery is necessary. Initial careful thoracoscopic dissection allows for safe placement of robotic ports and instruments. Further studies of robotic reoperative cardiac surgery are needed.
| Age | 66 +/- 14 |
| Male | 63% |
| Ejection Fraction | 49.6% +/- 16.6% |
| DM | 23% |
| Hypertension | 65% |
| CKD | 17% |
| Hyperlipidemia | 51% |
| CVA | 17% |
| Redo Redo | 9% |
| Euroscore | 6.7% +/-6.1% |
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