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Robotic-assisted cardiac surgery: anesthetic and postoperative considerations
Nicola D'Attellis1, Didier Loulmet, Alain Carpentier
1Department of Anesthesiology and Critical Care, Broussais Hospital. Nicola.D-Attellis@hop.egp.ap-hop.paris.fr
Objective:
To assess the feasibility of endoscopic telemanipulated cardiac surgery and describe the anesthetic, postoperative, and surgical implications of minimally invasive robotic-assisted cardiac surgery.
Design:
Prospective study.
Setting:
Cardiovascular and transplant center, university hospital.
Participants:
Twenty patients (13 men, 7 women) scheduled for either coronary artery bypass graft surgery or valve surgery. Mean age was 53 +/- 5 years (range, 31 to 75 years) and mean New York Heart Association class was 2.4. Three patients (6 %) were having redo procedures, and 1 patient had bacterial endocarditis.
Interventions:
Surgery was done with the aid of the daVinci surgical robot (Intuitive Surgical, Mountain View, CA). Induction and maintenance of anesthesia consisted of a target-controlled infusion of remifentanil and propofol. In 11 cases (55%), cardiopulmonary bypass was performed with Port-Access technology (Heartport, Redwood City, CA), and in the remaining 9 cases (45%), conventional femorofemoral bypass was used.
Measurements And Main Results:
Fifteen patients (75 %) were extubated within 6 hours and discharged from the cardiac surgery intensive care unit on postoperative day 1. Two patients (10%) were reexplored in the immediate postoperative period. Two conversions to thoracotomy were reported. One reoperation at 6 months and 1 late death occurred. At 1-year follow-up, excellent functional results were observed in 18 cases.
Conclusion:
Caution should be used when assessing innovative medical-surgical techniques. Despite technical difficulties and lengthy procedures, results were satisfactory. The feasibility of robotic-assisted surgery for coronary artery bypass graft and valve procedures is intuitively appealing.