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Surgery Grand Rounds - Downstate 2018

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Grand rounds presentation provided an overview of robotic heart surgery.

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Surgery Grand Rounds - Downstate 2018

  1. 1. Robotic Heart Surgery Robert Poston, MD Chief, Division of Cardiothoracic Surgery SUNY-Downstate, Brooklyn, NY
  2. 2. COMMON PRACTICE COMMON COMPLICATION Ultrasound probe Ultrasound image Partial cross clamp Aorta Aorta
  3. 3. ON-PUMP CABG
  4. 4. PROBLEM WITH OFF-PUMP
  5. 5. 10% 5% 1.6% 1970 1980 1990 2000 2010 INCIDENCE OF STROKE AFTER BYPASS GRAFTING OVER TIME
  6. 6. ON-PUMP CABG MINIMALLY INVASIVE CABG/HYBRID
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. Ann Thorac Surg 2018;106:691–5
  11. 11. Hallinan JT. Wall Street Journal. June 21, 2005
  12. 12. Impact of R-CABG on Postop Strokes • Hospital costs • Postacute care • Return to work • Malpractice premiums • Word of mouth reputation

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