Robotics

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.

Image

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."