Robotics

In today’s 11:30 a.m. session, "Robotic Cardiac Surgery: The Future Is Now," Dr. Tedy Sawma will discuss how mitral regurgitation, increasingly common in aging populations, presents unique challenges for older patients considering surgical treatment options. While mitral valve repair remains an effective solution, the invasiveness of traditional open-heart surgery often discourages both patients and healthcare providers.

In the Outcomes of Robotic Mitral Valve Repair in Patients Older Than 65 Years presentation, study investigators will highlight findings on robotic mitral valve repair in older patients, comparing outcomes with those from traditional median sternotomy. The study evaluates both short-term and long-term outcomes to determine whether robotic surgery offers advantages in recovery, quality of life, long-term survival, and the need for future interventions.

Researchers analyzed data from a cardiovascular surgery database, tracking patients who underwent their first isolated mitral valve repair between 2010 and 2024. They compared the outcomes of robotic procedures with those of traditional median sternotomy surgeries, adjusting for factors like age, gender, and comorbidities.

Primary outcomes included long-term all-cause mortality and the need for reinterventions, while secondary outcomes focused on hospital recovery metrics such as blood transfusions, atrial fibrillation rates, and ICU stay durations.

The findings to be discussed include how robotic mitral valve repair offered short-term advantages over traditional surgery, such as reduced ICU and hospital stays, fewer blood transfusions, and lower rates of postoperative atrial fibrillation. However, no significant differences were observed in long-term survival or the need for future interventions. Both groups maintained excellent physical activity levels and quality of life over the years. These results suggest that robotic mitral valve repair is a viable option for older patients, providing enhanced short-term recovery without compromising long-term outcomes.

In a landmark achievement for healthcare in Southeast Asia, St. Luke's Medical Center has launched the region's first robotic cardiac surgery program. This historic initiative was made possible through a collaborative effort between St. Luke's multidisciplinary team, led by Drs. Marvin Martinez and Ramiro Pablo, and the expert team from West Virginia University's (WVU) Heart and Vascular Institute, including Dr. Vinay Badhwar, Dr. Lawrence Wei, and physician assistant Herald Fe.

The program debuted with a series of innovative robotic-assisted cardiac procedures, showcasing the transformative potential of this advanced technology. Among the groundbreaking surgeries performed were:

• Robotic MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)
• Robotic bileaflet mitral valve repair for severe mitral regurgitation (MR) due to bileaflet myxomatous disease
• Robotic mitral valve repair for endocarditis, including anterior mitral leaflet perforation
• Robotic adult congenital atrial septal reconstruction using a bovine patch for a patient with a common atrium
• Robotic aortic valve replacement (AVR) for a patient from Papua New Guinea

The first robotic valve surgery—a repair of a severely regurgitant mitral valve in a 40-year-old patient—marked a defining moment in the program's success. With guidance from WVU's Heart and Vascular Institute, the procedure was completed with precision and excellence, underscoring the collaboration's impact.

Dr. Pablo expressed his excitement, saying, "This is a monumental step forward for cardiac care in Southeast Asia. Our partnership with the WVU team has empowered us to provide patients with less invasive, highly precise procedures and faster recoveries."

Dr. Martinez added, "Establishing this robotic cardiac surgery program has been a dream realized through our team's dedication and the invaluable expertise of our WVU partners. This is just the beginning of a new era in cardiac care."

Reflecting on the collaboration, Dr. Badhwar remarked, "Teamwork truly makes the dream work. The exceptional multidisciplinary team at St. Luke's has shown that vision, determination, and collaboration can achieve extraordinary outcomes."

St. Luke's Robotic Cardiac Surgery Program is set to advance care across the region, offering minimally invasive options that reduce pain, recovery time, and the risk of complications. 

A groundbreaking surgical achievement has been made by the team at West Virginia University (WVU) Heart and Vascular Institute, led by Dr. Vinay Badhwar, the executive chair of the WVU Heart and Vascular Institute and the second vice president of the Society of Thoracic Surgeons. On October 31, 2024, the team performed the world’s first combined robotic aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) through a single small incision.

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The pioneering procedure was performed on 73-year-old Poppy McGee, a patient with a complex medical history, including a stroke, brain surgery, and significant weight loss. Referred to Dr. Badhwar for treatment of both aortic valve disease and coronary artery disease, McGee initially faced the prospect of traditional open-heart surgery. However, when she and her family learned of its risks—over a 10% chance of mortality and nearly 50% likelihood of complications—they inquired about alternative options.

Dr. Badhwar explained his team had developed a novel robotic approach that had yet to be tested on a patient. After a thorough discussion of the risks and benefits, McGee and her family agreed to proceed with the innovative robotic surgery.

The procedure involved both AVR and CABG, performed entirely robotically through a single incision on the far right of McGee’s chest. The success of the surgery has sparked optimism about the potential for broader adoption of robotic heart surgery for patients with complex conditions.

“While we are still in the early days of this latest innovation, the ability to perform valve surgery and coronary artery bypass surgery fully robotically through a single incision has the potential to open up a new era of robotic heart surgery,” Dr. Badhwar noted in a prepared statement. “We must always keep quality outcomes at the forefront of all innovation. However, if surgeons adopt and gain experience with techniques such as this one, they will tackle this last frontier that previously limited a robotic approach. One day in the near future, this may serve as a platform to perform nearly all types of heart surgery.”

This revolutionary procedure potentially paves the way for less invasive operations. Dr. Lawrence Wei, a professor at the WVU Department of Cardiovascular and Thoracic Surgery, remarked on the impact of this advancement: "Patients who have both valve disease and coronary artery disease have traditionally been treated by open-heart surgery performed through the breastbone. This new robotic technique could redefine how we approach these cases."

Dr. Goya Raikar, an assistant professor at WVU and a member of Badhwar’s robotics team, also underscored the procedure's significance: "Until now, the main exclusion for us to perform a robotic approach has been the coexistence of valve and coronary artery disease. Building on our experience with robotic aortic valve surgery, this new approach may help us extend robotic surgery options to many more patients."

The patient’s daughter, Mollie Wilcosky, expressed gratitude for the groundbreaking care provided by the WVU team. “We are so thankful for Dr. Badhwar and the team at the WVU Heart and Vascular Institute for developing this robotic procedure to help my mother recover so well,” Wilcosky said. “She is getting stronger every day.”

The full details of the procedure will be in The Annals of Thoracic Surgery, highlighting how innovative approaches like this continue to redefine the future of cardiothoracic surgery.

References:
•    Cardiovascular Business article on the WVU Heart and Vascular Institute's groundbreaking surgery.
•    WV News article detailing the multidisciplinary team and procedural innovations at WVU Medicine’s WVU Heart and Vascular Institute.
 

The STS Workshop on Robotic Cardiac Surgery held May 9-10 in Peachtree Corners, Ga., offered 80 surgeons from across the country two days of hands-on team training for mitral valve repair, coronary bypass, and other surgery procedures in a cardiac robotics simulation environment.

Here are the top five benefits that surgeon attendees received from the experience:

1. Innovation: Attendees trained in robotic mitral valve procedures and robotic coronary revascularization using the latest techniques and technology. Multiple operating bays fitted with surgical robots allowed participants to sit at the console to control the robots.  

2. Training: The program offered a variety of educational activities for surgeons, including real-world simulations, case videos, faculty discussions, emphasized patient selection, perioperative management and postoperative care, and operative techniques.

3. Collaboration: The workshop was designed for both beginner robotic surgical teams who are looking for fundamental information and guidance on how to build a program, as well as advanced robotic surgical teams already practicing cardiac surgery robotics and are looking to continually improve the efficiency and effectiveness of their program.  

4. Access to luminary experts in the field: The workshop was led by world-renowned robotic heart surgeons. The surgeons who served as faculty not only mastered the use of robotics in cardiac surgery, but they also helped define it. 

5. Networking: Robotic Cardiac Surgery Workshop attendees connected with surgeons from across the country who are on the cutting edge of robotic cardiac surgery. 

Feedback on the conference was overwhelmingly positive. Here are a few highlights:

• "The best presentation was the one on preoperative criteria and assessment for robotic mitral valve patients." 
• "The session content was helpful for those thinking about starting a robotic mitral valve program." 
• "The presentations given by early-stage faculty on difficult cases where they had to convert to open were very helpful." 
• "Dr. Joanna Chikwe's session on complications of mitral valve repairs was wonderful.  I loved this presentation."
• "The most valuable sessions were those that offered peer-to-peer interaction with the experienced surgeons, including the hands-on lab."
• "I think the courses being part lecture and part hands-on gave the background and data to support what we are doing in the lab.  Even more hands-on time would be great, as well."