Developing Proficiency in Robotic Cardiac Surgery.

Background: The purpose of this review is to provide recommendations for cardiac surgeons interested in adopting a robotic platform into their programs.

Methods: The recommendations are based on the experience of the authors and cover a diverse array of cardiac surgical procedures that are currently performed with robotic assistance. The focus, as with any innovative surgical approach, is to ensure patient safety, maximize quality and efficacy, and set realistic expectations about what is required to achieve proficiency in robotic cardiac surgery.

Teaching the next generation of robotic coronary surgeons.

Robotic-assisted coronary bypass is an attractive option in the management of patients with isolated left anterior descending artery (LAD) disease or multi-vessel coronary disease providing the benefits of the left internal mammary artery (LIMA) to the LAD graft while avoiding the morbidity of a sternotomy. Although the learning curve is significant, both cardiothoracic surgery trainees as well as experienced coronary surgeons can learn this technique. As the prevalence of patients requiring these procedures increases, we must be prepared to respond by increasing our training of robotic coronary surgeons.

Transthoracic Aortic Clamp Technique for Port-Only Endoscopic Robotic Mitral Surgery.

Objective: Many robotic mitral surgeons utilize right thoracotomy with transthoracic clamping of the aorta, while a smaller number employ a port-only endoscopic approach with endoaortic balloon occlusion of the aorta. We present our technique for a port-only endoscopic robotic approach with transthoracic clamping.

Methods: From July 2019 through December 2022, 133 patients underwent port-only endoscopic robotic mitral surgery with transthoracic clamp aortic occlusion and antegrade cardioplegia.

Mastering the Learning Curve for Robotic-Assisted Coronary Artery Bypass Surgery.

Background: Previous studies have evaluated the learning curve to achieve competency in robotic-assisted coronary artery bypass grafting (CABG) but have not identified thresholds for mastery. Robotic-assisted CABG is a minimally invasive alternative to sternotomy CABG. The purpose of this study was to evaluate the short- and long-term outcomes of this procedure and to estimate the threshold for achieving mastery.

Endoscopic Robotic Mitral Valve Surgery in Patients With Previous Sternotomy Cardiac Surgery.

Mitral surgery is higher risk in patients with a previous median sternotomy. We describe an endoscopic robotic approach in this higher-risk cohort by an experienced robotic team. From January 2006 through June 2021, 152 consecutive patients with previous sternotomy cardiac surgery underwent mitral surgery using endoscopic robotics.

Surgical Correction of Tricuspid Regurgitation.

The tricuspid valve is an often forgotten but relevant cause of significant morbidity and mortality. Serious consideration should be given to addressing the valve in patients undergoing left-sided valve surgery who have functional TR, or an enlarged annulus. Tricuspid repair with a ring annuloplasty has shown improved long-term survival and freedom from recurrent TR at as long as 15 years of follow-up compared to suture annuloplasty or other repairs where a prosthetic ring is not used.