Early Results of Robotically Assisted Congenital Cardiac Surgery: Analysis of 242 Patients

Robot‐assisted beating‐heart surgery for atrial septal defect repair in a case of situs inversus totalis with dextrocardia

“…4 Currently, robotic assistance for cardiac surgery is mainly used in mitral valve surgery, congenital cardiac surgery, and coronary artery bypass grafting. 5,6 The efficacy and safety of robotic cardiac surgery have been confirmed and described in many studies, and the procedure has a mean 30-days mortality of 0.7% (0%-0.8%). 7 In recent years, the use of robotic cardiac surgery has significantly increased.…”

From Other Journals: A Review of Recent Articles by Our Editorial Team

“…Despite this, the adoption of robotics in congenital cardiac surgery has remained limited. In this study, the authors from Turkey reviewed their 8 year single-center experience with robotic congenital cardiac operations [ 5 ].…”

“…57 patients (14%) with the composite outcome (46 death, 7 heart transplant and 4 heart transplant listing) Elevated ventricular end diastolic volume (EDVi) was the strongest risk factor for the composite outcome with a threshold above 156 ml/BSA 1.3 Ventricular dilation by CMR was the strongest predictor of worse outcomes along with other risk factors including worse circumferential strain, worse functional status, and worse global function index Liu et al The Fate of Congenitally Corrected Transposition of the Great Arteries (ccTGA) Unoperated Before Adulthood [ 4 ] The outcomes, therapeutic strategies, and risk factors associated with ccTGA combined with associated cardiac lesions remain unclear 117 patients over a span of 9 years 3 groups: IVS, VSD and PS The PS groups had significantly less systemic AVV regurgitation and ventricular dysfunction and highest systemic ventricle ejection fraction 49 patients underwent surgery with no hospital mortality IVS group: patients receiving systemic atrioventricular valve replacement/ valvuloplasty had a significantly increased systemic ventricular ejection fraction and statistically more freedom from death and transplant than unoperated VSD group: late systemic ventricular ejection fraction of operated patients was not statistically different PS group: had significantly decreased systemic ventricular ejection fraction PS protects against systemic atrioventricular valve regurgitation and ventricular dysfunction Physiologic repair was not ideal for ccTGA with PS. Severe systemic atrioventricular valve regurgitation and systemic ventricular dysfunction were associated with suboptimal outcomes Onan et al Early Results of Robotically Assisted Congenital Cardiac Surgery: Analysis of 242 Patients [ 5 ] 242 patients underwent robotic surgery from 2013–2020 Most common defect: secundum ASD, 74.7%; sinus venosus ASD 16%, PAPVC10.7% No mortality Operative complications included aortic laceration, aortic bleeding, pleural bleeding, injury to SVC, left atrial appendage and femoral artery Ventilation time, intensive care unit stay, and the length of hospital stay were 5.2 + / − 2.9 h, 16.8 + / − 2.5 h, and 3.5 + / − 1.1 days, respectively Postoperative rates of stroke, cardiac events, pulmonary complications, and reexploration were 0.4%, 2.4%, 4.1%, and 0.8%, respectively Robotic technology can be utilized to perform suitable congenital operations safely and effectively albeit there is a learning curve Riggs et al Risk of Pediatric Cardiac Surgery Increased in Patients Undergoing Tracheal Surgery During the Same Hospitalization [ 6 ] Most common airway anomaly: congenital tracheal stenosis, tracheoesophageal fistula PHIS database, < 18 years old, 2005–2014 2 groups: CHS + TS, CHS alone propensity matched 2:1 Total number of patients 46,497, 283 in CHS + TS and 566 in CHS only group CHS + TS – increased mechanical ventilation, acute kidney injury, total parenteral nutrition Hospital mortality 13.8% for CHS + TS, 5.8% for CHS group Surgical complications 59% CHS + TS, 43% CHS group MV analysis risk factors for mortality: TS, ECMO, acute kidney injury, TPN The authors concl...…”

Minimal-Access Atrial Septal Defect (ASD) Closure

“…As minimal-access and minimally invasive cardiac surgical techniques advance, the role for robotic surgery is increasingly considered. The use of robotic surgery for ASD closure has been reported for a cohort of 54 adult and paediatric cases with secundum ASD using the da Vinci robotic system, with the cannulation of the femoral vessels and right internal jugular vein [59]. As with all developing techniques, significant learning curves were reported, evidenced by cross-clamp time, cardiopulmonary bypass time and operative duration, with the authors concluding that ASD closure can be safely and effective performed using a totally endoscopic approach and robotic surgery.…”