Robotic-Assisted Minimally Invasive Myocardial Revascularization: Our Center’s Experience

E. Karvana; M. Rufa; A. Ursulescu; M. Ghinescu; P. Di Pietrantonio; M. Albert; N. Göbel; U. Franke; B. Rylski

doi:10.1055/s-0045-1804035

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2025; 73(S 01): S1-S71
DOI: 10.1055/s-0045-1804035

Sunday, 16 February

MINIMALINVASIVE KORONARCHIRURGIE

Robotic-Assisted Minimally Invasive Myocardial Revascularization: Our Center’s Experience

Authors

E. Karvana

¹Robert-Bosch-Hospital, Stuttgart, Deutschland
M. Rufa

¹Robert-Bosch-Hospital, Stuttgart, Deutschland
A. Ursulescu

¹Robert-Bosch-Hospital, Stuttgart, Deutschland
M. Ghinescu

¹Robert-Bosch-Hospital, Stuttgart, Deutschland
P. Di Pietrantonio

¹Robert-Bosch-Hospital, Stuttgart, Deutschland
M. Albert

¹Robert-Bosch-Hospital, Stuttgart, Deutschland
N. Göbel

¹Robert-Bosch-Hospital, Stuttgart, Deutschland
U. Franke

²Universitäts-Herzzentrum Freiburg • Bad Krozingen, Freiburg im Breisgau, Deutschland
B. Rylski

¹Robert-Bosch-Hospital, Stuttgart, Deutschland

Abstract

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Background: Surgical coronary artery bypass grafting has been the gold standard treatment for coronary revascularization, particularly for left coronary artery disease. The development and refinement of the robotic-assisted minimally invasive myocardial revascularization approach have been driven by the desire to offer the proven benefits of coronary revascularization while minimizing the side effects associated with traditional on-pump procedures. This technique is particularly important as it can be used in combination with percutaneous stent implantation, providing a hybrid therapy approach. In the following sections, we present our center’s experience with robotic-assisted minimally invasive myocardial revascularization.

Methods: This is a retrospective analysis of early outcomes in patients who underwent robotic procedures.

Results: From July 2019 to August 2024, we performed a total of 269 bypass operations assisted by the da Vinci Robotic System. 104 (38,4%) patients had a history of acute myocardial infarction prior to the operation, and 106 (39,4%) had undergone a PTCA. 58 (21.6%) patients had an EF < 50%. The grafts used were the left and right internal mammary arteries in 268 (99.6%) and 84 (31.4%) cases, respectively. In some cases, the saphenous vein was also utilized. A heart-lung machine was required for support in 8 (2.97%) patients, while a conversion to sternotomy was necessary for 11 (4.08%) patients. Postoperative complications included myocardial infarction within the first 30 days in 14 (5.2%) patients, requiring re-thoracotomy, either due to hemorrhage or graft issues in 9 (3.34%) patients. The majority of patients spent only 1 day in the ICU. For 214 (79.6%) patients, the overall hospital stay ranged from 4 to 8 days. A hybrid procedure was planned for 77 (28.6%) patients. Complete revascularization was achieved in 212 (79.1%) cases, while 11 (4.08%) patients underwent the procedure as a palliative therapy option.

Conclusion: Robotic-assisted minimally invasive myocardial revascularization has become a routine procedure at our hospital, with satisfactory results. It is planned for stable, elective patients. Proper planning for patients undergoing a planned hybrid procedure is crucial for the success of this approach, before they are discharged from the hospital.