Background and Objective: Robotic coronary artery bypass surgery is an established procedure for treatment of coronary artery disease. The goal of this manuscript is to provide an overview on how to build a successful robotic coronary artery bypass grafting (CABG) surgery program and analyze its learning curve. Methods: We performed a narrative review of the current medical literature comparing the robotic CABG survival rate. English literature published by January 30th, 2021 were searched in PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL and Google Scholar. Key Content and Findings: The learning curve of robotic CABG is a stepwise process ranging from proficiency in off-pump CABG to multi-vessel robotic totally endoscopic CABG. Robotic CABG creates a unique setting where all the team members (including surgeons, anesthesiologists, and nurses) face the technical and logistic challenges of a new procedure, relying on the team assistance and medical knowledge. A careful selection of the team based on their experience and keen interest in the program is highly advisable. Team synergy and attention to details are key to the program success. It is recommended that every team member had previous training in the operating room with the robotic platform either on cadavers or animals. A synergistic collaboration among surgeon, hospital administration, and chief of the department through defining reasons are keys for developing a successful robotic surgical program and setting future goals for the team and the department. In addition, the ideal pathway of a successful trainee for patient selection consists of: (I) patient with stable coronary artery disease; (II) double vessels disease with a non-anterior descending artery (LAD) target that can be treated with stent; (III) robotic CABG left internal thoracic artery (LITA) to LAD followed by stenting of the non-LAD territory with angiographic confirmation of LITA to LAD patency; (IV) adding a second internal thoracic artery (ITA) should be evaluated carefully and after performing at least 75/100 cases of single LITA to LAD. In addition, literature review found 46 studies and 9,228 patients were included. Conclusions: Robotic CABG is a constantly evolving field and new programs are constantly built. Bearing in mind the benefits of the procedure, a stepwise growing of the program is essential in becoming a leader in the field.
Graphical Abstract Factors increasing post CABG incidence of ischemic stroke (red) and those which were not significant at the multi-model multifactorial analysis that analyzed all technical factors alone or in different combinations (green).
In this article, we focus on the important role of robot-assisted coronary surgery by reporting the successful case of a morbidly obese male (body mass index = 58 kg/m2) who presented to our center with severe coronary disease. A 54-year-old morbidly obese male presented with acute chest pain and was diagnosed with coronary artery disease. The culprit lesion was the left anterior descending (LAD) coronary artery. A percutaneous coronary intervention angiography attempted in a university hospital was not successful. Our heart team chose a hybrid robot-assisted revascularization (HCR) strategy based on the patient's body size. The patient underwent left internal thoracic mammary artery to LAD bypass with uneventful postoperative recovery. Robotic HCR is a valuable strategy in morbidly obese patients undergoing coronary artery bypass grafting.
Introduction: We aim to analyze multicenter long-term clinical outcomes of minimally invasive aortic valve replacement (MI-AVR) in patients with aortic valve disease. Hypothesis: We hypothesize that MI-AVR provides good long-term clinical outcomes in patients undergoing aortic valve surgery. Methods: All consecutive 1,972 patients undergoing MI-AVR with either ministernotomy (n= 986) or right anterior minithoracotomy (RAM, n=986) between 1999 and 2019, were included. Primary outcomes were all-cause mortality and cardiac death. Results: Preoperatively, mean age was 72.1 (±13.7) year-old, and mean STS-PROM risk score was 0.38%. Intraoperatively, mean operative time (min) was 213.97 (± 56.9), while 313 (15.9%) patients were converted to full sternotomy. Postoperatively, 69 (3.5%) patients had prolonged mechanical ventilation (< 24 hours), 59 (3%) patients had re-exploration for bleeding, 10 (0.5%) patients had paravalvular leak (moderate/severe), 22 (1.1%) patients had non-fatal stroke, and 28 (1.4%) patients had non-fatal myocardial infarction. Mean intensive care unit stay was 14.45 (± 10.15) hours, and mean hospital length of stay (LOS) was 7 (± 3.5) days. Thirty-day all-cause mortality occurred in 39 (2%) patients while 30-day cardiac-death occurred in 23 (1.2%) patients. Thirty-day predictors for all-cause mortality included age <75-years, post-operative LOS, peri-operative stroke, and RAM. Mean follow-up time was 10-years. At 20-year follow-up, all-cause death and CV-death incidence were 1156 (60%) and 170 (8.8%) patients, respectively. Valve-related deaths occurred in 33 (1.7%) patients. Long-term predictors for all-cause mortality included age <75-years, chronic kidney failure, mechanical ventilation <12 hours, RAM, and hospital LOS <10 days. Conclusions: MI-AVR is a safe, valid, and reproducible surgical procedure for patients with aortic valve disease. In addition, it provides good long-term outcomes.
