Surgical and Anesthesia-Related Concerns forRobot-Assisted Pediatric Cardiac Surgery

The purpose of this study is to describe a cohort of pediatric patients undergoing robot-assisted cardiac surgery at a single center and to discuss the anesthetic implications and perioperative considerations to optimize outcomes.

A retrospective observational cohort study.

Academic tertiary care medical center.

Nine children underwent robot-assisted cardiac surgery from 2022 to 2024. Indications for operation included atrial septal defect (n = 8) and mitral valve regurgitation with concomitant Marfan syndrome (n = 1).

Eight patients underwent atrial septal defect closure; 1 patient underwent mitral valve repair.

Mean (SD) age was 13.1 (2.5) years, mean (SD) weight was 48.5 (20.3) kg, and mean (SD) body mass index was 21.7 (5.4) kg/m². Mean (SD) operative time was 388.2 (40.7) minutes, fibrillation time was 92.4 (25.8) minutes, and cardiopulmonary bypass time was 192.1 (31.3) minutes. None of the patients required 1-lung ventilation based on surgeon preference, and most patients (77.8%) were extubated in the operating room. The median (IQR) intensive care unit length of stay was 45 (26) hours, and the median (IQR) hospital stay was 3 (2.5) days. One patient required conversion to median sternotomy due to aortic insufficiency in the setting of Marfan syndrome and aortic root dilation. One patient required a reoperation due to bleeding following an emesis episode in the intensive care unit. There were no mortality events.

Robot-assisted cardiac surgery is well tolerated in appropriately selected pediatric patients, including children as small as 24 kg. Our experience suggests that the success of this approach is predicated upon a center with institutional experience and multidisciplinary collaboration. Furthermore, it is critical that the anesthesiologist understands the unique anatomic, airway, monitoring, positioning, and surgical considerations that are unique for this patient population.