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International Society For Minimally Invasive Cardiothoracic Surgery

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Elena Sandoval, Maria Ascaso, Anna Muro, Eduard Quintana, Jorge Alcocer, Manuel Castella, Daniel Pereda.
Hospital Clinic, Barcelona, Spain.

Background:Adoption of robotic technology in cardiac surgery, particularly in Europe, has been slow, partly because of the perceived technical complexity.    We are a group with more than 20 years of experience in thoracoscopic mitral surgery that has recently started a robotic surgery program; our objective is to report this initial experience.   Methods: Retrospective review of all patients who have undergone robotic surgery in our institution (December 2019-December 2020). Should this abstract be accepted, this cohort will be updated up to the moment of the meeting.   Results:  During this period, 40 patients have undergone robotic surgery (average 55.5y, 61.5% male). 34 patients had mitral surgery (31 repairs, 3 replacements), 4 patients had atrial septal defect (ASD) closure (one with concomitant tricuspid repair) and 2 patients had single-vessel off-pump coronary bypass (OPCAB). Among patients undergoing mitral repair, anterior, commissural or bileaflet prolapse was present in 31%. Five patients needed urgent surgery (2 OPCABG, 3 mitral repairs). All procedures were successful and there were no conversions to sternotomy (1 mitral replacement was completed thoracoscopically very early in our experience due to severe calcification). Four patients (3 mitral repair, 1 ASD) needed a second clamp time and 51% were extubated in the theater. Re-exploration for bleeding occurred in 3 patients (solved thoracoscopically in all). Median intensive care and hospital stay were 1 and 5 days. There was only one in-hospital death. For mitral surgery; median cardiopulmonary bypass and cross-clamp time were 152 and 109 minutes, respectively.  Comparing the first and second halves of our experience, we have seen a reduction in median intubation duration (4.5vs.0 hours; p=0.02) and a tendency towards a reduction in cross-clamp time (118vs.98min;p=0.09) and respiratory complications (75% of them in the first).   Conclusions: Our robotic cardiac surgery program is mainly focused on mitral valve repair and our initial results are satisfactory. We have experienced most difficulties at the beginning of our experience, which have improved significantly over time. Despite the existence of a learning curve, only one case was not fully completed robotically, all mitral repairs were successful and patients were discharged home after a median of 5 days.

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