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International Society For Minimally Invasive Cardiothoracic Surgery

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The Impact Of Robotic Cardiac Surgery With High-volume Patient Referral: An Early Single Center Experience
Feras Khaliel, Zainab Alayed, Mohammed Alamri, Adel Aly, Shahid Khan, Mosleh Alanazi, Matloob Shajar, Ziad Dahdouh, shisamma Emmanual, Hani Alsergani, Jehad Alburaiki, Mashael Alrujaib, Baha Fadel.
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Introduction: The introduction of Robotic technology has assisted minimally invasive cardiac surgery by allowing an endoscopic approach and thus facilitating surgical interventions on various conditions including structural heart diseases and coronary artery bypass grafting (CABG) via a minimally invasive approach. Material and Methods: We have retrospectively examined the first 9-month experience with Robotic cardiac surgery at our institution and we detail here the intra- and post-operative patient data and outcomes. Between February and October 2019, 50 patients underwent Robotic surgery. A right minithoracotomy using femoral cardiopulmonary bypass was performed on 44 patients including mitral valve replacement (MVR) (n = 24), MVR with tricuspid valve repair, Maze procedure and left atrial appendage ligation (n = 15), redo valve surgery (n = 4) and resection of pericardial tumor (n = 1). An off-pump left minithoracotomy was performed on the remaining 6 patients who underwent CABG on a beating heart. Results: Mean age was 50.2 13.7 years with 33 (69%) of the patients being female, 27 (56%) with a body mass index > 30 kg/m2 and 14 (29%) in atrial fibrillation. Pre-operative average left ventricular ejection fraction (LVEF) was 55%, 8 (17%) patients had right ventricular (RV) dysfunction and the average EuroSCORE II was 2. One patient (2%) died whereas 3 patients (6%) had either a myocardial infarction or heart failure in the post-operative period, 3 of whom required dialysis, 2 patients (4%) required hospital readmission following discharge and no patients required readmission to the intensive care unit. Additionally, four patients (8%) required reoperation. There was no significant change in LVEF following surgery. However, there was a significant decline in RV systolic function with post-operative dysfunction noted in 48% of patients, mostly in the mild range.Conclusion: Based on our initial experience with Robotic surgery with a main focus on mitral valve disease, we conclude that Robotic surgery can be performed relatively safely and effectively in most patients with some perioperative complications. We have observed a relatively fast recovery and low mortality rate in our series as well as a good preservation of LV systolic function. We appreciate the fact that perioperative complications can be further reduced as we gain more experience with this surgical approach.


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