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. 2017 Jan;6(1):17-26.
doi: 10.21037/acs.2017.01.01.

Robotic cardiac surgery in Brazil

Robinson Poffo  1 , Alisson P Toschi  1 , Renato B Pope  1 , Paola K Montanhesi  1 , Ricardo S Santos  1 , Alexandre Teruya  1 , Dina M Hatanaka  1 , Gabriel F Rusca  1 , Claudio H Fischer  1 , Marcelo C Vieira  1 , Marcia R Makdisse  1
Affiliations

Robotic cardiac surgery in Brazil

Robinson Poffo et al. Ann Cardiothorac Surg. 2017 Jan.

Abstract

Background: Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci® robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil.

Methods: From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy.

Results: The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term.

Conclusions: Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra- and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.

Keywords: Coronary artery bypass; Minimally invasive surgery; atrial septal defect; robotic surgery; valve surgery.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Robotic Surgery in Hospital Israelita Albert Einstein according to surgical specialties from 2008 to 2015.
Figure 2
Figure 2
Mitral valve regurgitation repair (P2 prolapse) due to a ruptured chordae using polytetrafluoroethylene neo chords and a complete semi-rigid ring.
Figure 3
Figure 3
Preoperative diagnosis. ASD, atrial septal defect; MiR, mitral regurgitation; MiRS, mitral regurgitation and stenosis; Coi, coronary insufficiency; AF, atrial fibrillation.
Figure 4
Figure 4
Types of surgical procedures. AFT, atrial fibrillation therapy.
Figure 5
Figure 5
Kaplan-Meier survival curve.
Figure 6
Figure 6
New York Heart Association functional class.
See this image and copyright information in PMC

References

    1. Lee JD, Srivastava M, Bonatti J. History and current status of robotic totally endoscopic coronary artery bypass. Circ J 2012;76:2058-65. 10.1253/circj.CJ-12-0981 - DOI - PubMed
    1. Chitwood WR, Jr. Robotic cardiac surgery by 2031. Tex Heart Inst J 2011;38:691-3. - PMC - PubMed
    1. Bonaros N, Schachner T, Lehr E, et al. Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: predictors of success and safety. Ann Thorac Surg 2013;95:803-12. 10.1016/j.athoracsur.2012.09.071 - DOI - PubMed
    1. Suri RM, Antiel RM, Burkhart HM, et al. Quality of life after early mitral valve repair using conventional and robotic approaches. Ann Thorac Surg 2012;93:761-9. 10.1016/j.athoracsur.2011.11.062 - DOI - PubMed
    1. Wikipedia. Minimally invasive procedures. Available online: https://en.wikipedia.org/wiki/Minimally_invasive_procedures

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