Implementation of Robotic Coronary Surgery after Established Mitral Robotic Program

Aims. We described our advancement in the field of robotic cardiac surgery, particularly in the context of coronary revascularization. We will outline how the application of the Da Vinci (R) X Surgical System in coronary surgery is safe, feasible, and reproducible after an adequate familiarization with the docking system, that could come from a previous mitral valve robotic program, and after a sufficient learning time period. Methods. Between February 2021 and December 2023, a cohort of 33 patients underwent coronary artery revascularization surgery, involving robotic harvesting of the left mammary artery and off-pump hand-direct bypass to the left descending coronary artery or marginal coronary artery. In cases of hybrid revascularization, percutaneous coronary intervention with drug-eluting stent placement was performed either before or after surgery. Results. There were no mortalities within 30 days and at 1 year of follow-up after surgery. Notably, 70% of patients were extubated in the operating room immediately following the surgical procedure. The median postoperative mechanical ventilation time was 0 [0-4] hours, and the median length of stay in the intensive care unit was 21 [20-48] hours. A progressive reduction of the console and instrumental Da Vinci (R) X Surgical System was underling after the 21st patient. Conclusion. The promising outcomes observed in this series highlight that robotic-assisted coronary artery bypass represents a well-established technique that could be reproducible, especially when integrated into a hybrid strategy. Initiating a program in robotic-assisted coronary artery bypass surgery can be effectively attained in particularly when a well-established background in Da Vinci (R) X Surgical System utilization is achieved.