Robotic Cardiac Surgery: 7-year Single-center Follow-up Results
Changqing Gao, MD, Ming Yang, MD, Huajun Zhang, MD, DPhil, Cangsong Xiao, MD, Yang Wu, MD, Gang Wang, MD, Yao Wang, MD, Jiali Wang, MS
Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
OBJECTIVE To demonstrate the follow-up results of 709 cases of various types of robotic cardiac surgery performed over last 7 years.
METHODS A total of 709 cases of robotic cardiac surgery were performed in our center using da Vinci Surgical System (Intuitive Surgical, USA) from 2007 to 2014. The patients’ median age was 47 (11 to 80) years and 61.3% were male. With right port approach, atrial septal defect repair on arrest or beating heart (n=190), ventricular septal defect repair (n=30), mitral valve repair (MVP, n=112) or replacement (MVR, n=44), atrial myxoma resection (n=55), and other pericardial or epicardial procedures (n=14) were completed. Cardiopulmonary bypass (CPB) was established through peripheral vascular cannulation. The Chitwood clamp was used to cross-clamp the ascending aorta. With left port approach, 240 cases of totally arterial robotic coronary artery bypass grafting were completed, including totally endoscopic coronary artery bypass grafting (TECAB, n=100) and coronary artery bypass grafting with mini-thoracotomy (MINICAB, n=140). Single or bilateral IMA were used for composite Y or sequential grafts in MINICAB. The patients with multiple-vessel disease received hybrid coronary revascularization in separate stages (n=24). The graft patency was assessed with CT angiography(CTA) 5 years postoperatively. All the robotic coronary bypass grafting were completed off-pump. Patients were followed up at 6 month, 1 year, 3 years, 5 years and up to 7.5 years postoperatively with clinical, echocardiographic and/or CT angiographic status assessed when indicated.
RESULTS All cases were successfully performed. No death from cardiac origin was noted in this patient series. Operating time was shortened significantly for all procedures with significant learning curves. During the follow-up length of 40.9 ±16.5 months (range, 1 to 86 months), no residual shunt, paraprosthetic leak, or recurrence of tumor was noticed. During robotic MVP, one case was converted to median sternotomy due to needle injury to aortic valve leaflet (0.9%). Postoperative echocardiography showed no residual (98%) or trace (2%) mitral regurgitation. Two post-operative deaths (1.8%), 3 strokes (2.7%) and 4 prosthetic failure (3.6%) was noted in the median follow-up of 50 months. The blood flow in IMA graft was 35.8±20.0 (10 to 103) ml/min after TECAB and 21.3±12.6ml/min after MINICAB. Two patient in TECAB group and 1 in MINICAB group required re-intervention of coronary arteries. Upper GI tract bleeding occurred after TECAB (1%) and wound infection (2.9%) happened after MINICAB. Approximately 93% of the patients were followed with coronary angiography or CTA scan in 41.1±12.9 months. The IMA graft patency was 97.1% in TECAB group and 96.4 % in MINICAB group over 3 years (up to 91 months) postoperatively.
CONCLUSIONS This study showed that robotic technique could be safely applied in many cardiac procedures for selected patients. The long-term follow-up results are excellent. We believe that the robotic surgery will be truly minimally invasive cardiac surgery in the future.