Invited presentation given on 5/18/16 about robotic surgery and the unusually low rate of postoperative strokes that are noted after this procedure.

1. Update on Less Invasive
Cardiac Surgery at St Francis
Robert Poston, MD
Chairman, Cardiothoracic Surgery

2. Less invasive
Open surgery
Less invasive
Open surgery
Prior to Feb 2015 Feb 2015 to May 2016
Less Invasive Cardiac
Surgery at SFMC

3. 0
0.5
1
1.5
2
2.5
3
3.5
Mortality Mortality and Morbidity
Outcomes for Heart
Bypass at St Francis
Feb ‘15 – March ‘16 (n=204)
15%
14.5
14
13.5
13
12.5
12
3%
2.5
2
1.5
1
0.5
0
Observed Expected
O/E
0.88
O/E
0.94

4. 0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
stroke deep SWI
Highly Morbid Complications
After Bypass at St. Francis
Feb ‘15 to March ‘16 (n=204)
0% 0%
SFMC Lourdes-Camden STS-National Average

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

7. PROBLEM WITH MULTIVESSEL GRAFTING WITH OFF-PUMP TECHNIQUES

8. 10%
5%
1.8%
1970 1980 1990 2000 2010
INCIDENCE OF STROKE AFTER BYPASS GRAFTING OVER TIME

9. ON-PUMP CABG MINIMALLY INVASIVE CABG/HYBRID

10. Conclusions – Stroke after Bypass
• Baseline rate of 1.5 – 2.0% due to
• Aortic manipulation with atheroembolism
• Periods of low blood pressure/poor brain blood flow
• Avoiding stroke after robotic bypass (0 out of 204) due to
• No touch surgical technique combined with PCI
• Excellent blood pressure during bypass grafting