Grand rounds presentation provided an overview of robotic heart surgery.

1. Robotic Heart Surgery
Robert Poston, MD
Chief, Division of Cardiothoracic Surgery
SUNY-Downstate, Brooklyn, NY

7. COMMON PRACTICE COMMON COMPLICATION
Ultrasound probe
Ultrasound image
Partial cross clamp
Aorta
Aorta

8. ON-PUMP CABG

9. PROBLEM WITH OFF-PUMP

10. 10%
5%
1.6%
1970 1980 1990 2000 2010
INCIDENCE OF STROKE AFTER BYPASS GRAFTING OVER TIME

12. ON-PUMP CABG MINIMALLY INVASIVE CABG/HYBRID

13. Database n Stroke ref
STS National Cardiac
Database 2006-12
9862 0.5% Whellan D,
ATS 2016
National Inpatient
Sample 2009-10
2582 0.4% P Cavallaro,
JTCVS 2015
National Inpatient
Sample 2008-9
132 0% Anderson,
JACS 2012
Meta-analysis of
clinical trials 2002-15
8034 0.7% Cao C, Ann
CT Surg 2016
NIH Observational
trial 2012-13
200 0% Puskas, JACC
2016
TOTAL 20,810 0.5%
Open CABG 155,012 1.8% 2017 STS-
NCD report
STROKES AFTER ROBOTIC CABG

14. Recovery at 3 weeks Open CABG Robotic CABG P value
Walking distance 0.5 ± 1.0 mi 1.7 ± 1.5 mi 0.04
Treadmill MVO2 (%
baseline)
43% 93% NS
6 min walk test 57% 97% 0.02
Duke Activity Index 49% 98% 0.02
Faster Recovery after Robotic CABG
Poston R. Wireless Technology Demonstrates that Physical Capabilities in the Early Phase of Recovery are
Enhanced by Less Invasive, Robotic CABG, ISMICS oral presentation, 2015

15. Epstein A, et al. Impact of Minimally Invasive Surgery on Medical Spending and Employee Absenteeism JAMA Surg. 2013;148(7):641-647.
Quicker Return to Work after Robotic CABG

16. Ann Thorac Surg 2018;106:691–5

17. Hallinan JT. Wall Street Journal. June 21, 2005

18. Impact of R-CABG on Postop Strokes
• Hospital costs
• Postacute care
• Return to work
• Malpractice premiums
• Word of mouth reputation