Outcomes Comparison Of Robotic-assisted And Video-assisted Thoracoscopic Cardiac Sympathetic Denervation
Albert Leng1, Kelsey Melinosky1, Christopher R. Johnson1, Katherine Giuliano1, Eric Etchill1, Harikrishna Tandri2, Malcolm V. Brock3, Jinny Ha3.
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BACKGROUND: Cardiac sympathetic denervation (CSD) is a surgical antiadrenergic procedure that can reduce sustained ventricular tachyarrhythmia (VT) and implanted cardioverter defibrillation (ICD) shocks. Video-assisted thoracoscopic surgery (VATS) is currently the standard approach utilized in CSD, however, the practicality for robot-assisted thoracoscopic surgery (RATS) has yet to be investigated.
METHODS: We conducted a single-center retrospective study of all adult patients (n=65) who underwent CSD from 2019 to 2021 and collected follow-up data up to at least one-year post-operation. Patients were stratified into two groups: those who underwent RATS denervation and those who underwent VATS denervation. In robotic-assisted CSD, the sympathetic chain was removed from the inferior aspect of the stellate ganglion to the fourth intercostal space.
RESULTS: A total of thirty-two patients underwent RATS cardiac denervation and thirty-three underwent VATS cardiac denervation. Compared to the VATS cohort, the RATS cohort had a significantly higher number of male patients (p=0.003); all other demographic characteristics were not significant.
Those undergoing RATS denervation had significantly shorter procedure durations with a median of 127 minutes (p=0.005) and less estimated blood loss (p<0.001); but, when adjusting to only account for blood loss of 50 mL and above, the significance disappears (p=0.109).
Patients receiving the VATS approach were significantly complicated by pneumothorax (p=0.005) when compared to the RATS approach. At one-year post-op, both groups had significant reductions in ICD shocks compared to pre-op, both decreasing from a median of 4 to 0 shocks (p<0.001). Additionally, at one-year post-op, the percentage of patients with persistent ICD shocks and the median of ICD shocks were similar between groups. No conduction changes occurred as PR and QT intervals were not significantly different between pre- and post-op for both VATS and RATS denervation.
CONCLUSIONS: The RATS approach to cardiac denervation has similar one year follow-up outcomes in reducing recurrent VT as the VATS approach, however, patients undergoing RATS denervation experienced better peri-operative outcomes. This shows promise for robotic CSD to be an effective therapeutic option for patients with malignant arrhythmias.
HEADING: Table 1: Pre-, peri-, and post-operative variables of patients undergoing RATS or VATS cardiac denervation. 
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