Efficacy and safety of robotic-assisted versus median sternotomy for cardiac surgery: results from a university affiliated hospital

BACKGROUND: We aimed to report the experience of robotic-assisted cardiac surgery (RACS) using the Da Vinci robotic surgical system, meanwhile its efficacy and safety was also evaluated by comparing with traditional open-heart surgery (TOHS), thus to provide evidence for a broader application of RACS in clinical practice. METHODS: From July 2017 to May 2022, a total of 255 patients who underwent cardiac surgery assisted by Da Vinci robotic surgery system in the First Affiliated Hospital of Anhui Medical University, which included 134 males with an average age of 52.6±6.3 years and 121 females with an average age of 51.8±5.4 years. They were defined as the RACS group. By searching the hospital’s electronic medical record information system, 736 patients with the same disease types who underwent median sternotomy and had complete data in the same period were selected as the TOHS group. Intra- and postoperative clinical results of the both groups were compared, and we focused the following indices including surgery time, reoperation rate for postoperative bleeding, length of intensive care unit (ICU) stay, postoperative hospitalization day, the number of died and withdrawing treatments, and the time of patients back to normal daily activities after discharge. RESULTS: In RACS group, 2 patients were scheduled to undergo mitral valvuloplasty (MVP), but they had to change to mitral valve replacement (MVR) due to unsatisfactory results; furthermore, 1 patient who received atrial septal defect (ASD) repair experienced abdominal hemorrhage because a rupture of abdominal aorta which were induced by the femoral arterial cannulation, and this patient eventually died of invalid rescue. As for the comparison of clinical results between both groups, there were no significant statistical differences in reoperation rate for postoperative bleeding, and the number of died and withdrawing treatments between both groups. However, length ICU stay, postoperative hospitalization day, and the time of patients back to normal daily activities after discharge was lower in RACS group in addition to the surgery time. CONCLUSIONS: Compared with TOHS, RACS is safe and effective in clinical and is worthy of promotion in an appropriate place.