Establishment of a Robotic Cardiac Program: Learning Curve and Results of the First 100 Patients

Objectives: Only few centers worldwide have realized a cardiac robotic program using the Da Vinci System over the last two decades. There is a discussion about the cost effectiveness of this high technical device. Additionally, the implementation of this demanding system is not trivial. This study should analyze the initial establishment phase regarding safety and learning curve of this technology.

Methods: The first 100 robotic supported cases operated on between July 2019 and June 2020 were analyzed regarding time consumption, complications and outcome. Only two surgeons supported by a defined OR-team of three table assistants and three scrub nurses had done operations.

Result: Operations were 26 minimally invasive totally arterial OPCAB procedures, 15 MIDCAB, 53 mitral valve repairs, 3 ASD patch closures, and 3 myxoma resections. Concomitant procedures during MVR were TVR (10), LA cryoablation (17), and LAA closure (18). There was no 30-day mortality. The average OR times are shown in [Table 1]. OR time as well as X-clamp time showed a significant decrease during the observational period.

Table 1

	OR time in min	CPB time in min	X-clamp in min	ICU stay in h (median)	Hospital stay in d (median)
MIDCAB	173.3	0	0	11.1	4.7
OPCAB (LITA + RITA)	275.1	0	0	17.7	6.2
MVR	255.8	190.6	99.8	55.5	7.5
ASD closure	217.5	148.2	66.5	13.3	7.2
Myxoma resection	178.7	125.3	36.7	8.1	5.3

Conclusion: The Da Vinci system allows safe operations and a stiff learning curve even during the initial establishment phase.

Publication History

Article published online:
19 February 2021