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Robotic-assisted Cardiac Surgery without Aortic Cross-clamping: A Safe Alternative Approach
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  • Ahmet Gullu,
  • Sahin Senay,
  • Egemen Ersin,
  • Önder Demirhisar,
  • Muharrem Kocyigit,
  • Cem Alhan
Ahmet Gullu
Acibadem Maslak Hospital
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Sahin Senay
Acibadem Maslak Hospital
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Egemen Ersin
Acibadem Maslak Hastanesi
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Önder Demirhisar
Acibadem Maslak Hospital
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Muharrem Kocyigit
Acibadem Mehmet Ali Aydinlar University
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Cem Alhan
Acibadem Maslak Hospital
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Abstract

Background and Aim: Attempting to place an aortic cross-clamp may complicate surgery and post operative outcomes in patients who have mediastinal adhesions or in those with extensive aortic calcification. Although right sided cardiac surgery via thoracotomy is not a new technique in these patients, robotic-assisted intracardiac repair without cross-clamping was not reported in a large group of patients previously. In this study, the safety of robotic-assisted cardiac surgery without aortic cross-clamping was examined. Methods: From January 2010 to March 2020, 304 patients underwent robotic-assisted cardiac surgery in our center and in 25 of these patients (8.2%) with a mean age of 65.5±20 years myocardial protection was succeeded with moderate hypothermic ventricular fibrillatory arrest. Severe pericardial adhesions or existence of highly calcified ascending aorta were the indications for fibrillatory arrest during robotic assistant surgery. Results: Most patients were in NYHA class ≥II (88.0%) and mean logistic Euroscore value was 18.5±22.3. The type of the operations were mitral/tricuspid valve repair/replacement, Cryoablation, ASD closure and pericardiectomy. CPB times were 141.5±47 (min 77- max 252) minutes. There was no case of conversion to open thoracotomy or sternotomy. Hemiparesis was observed in one patient. Two patients with 78.2 and 81.9 Euroscore values had mesenteric ischemia and multi-organ failure, respectively, and died at postoperative period. Conclusions: Robotic-assisted cardiac surgery without cross-clamping may provide reasonable outcomes in patients with severe aortic calcification or mediastinal adhesions undergoing intracardiac repair. These acceptable outcomes may encourage surgeons to perform this approach in appropriate group of patients.

Peer review status:IN REVISION

28 Jun 2020Submitted to Journal of Cardiac Surgery
27 Jul 2020Submission Checks Completed
27 Jul 2020Assigned to Editor
28 Jul 2020Reviewer(s) Assigned
17 Aug 2020Review(s) Completed, Editorial Evaluation Pending
17 Aug 2020Editorial Decision: Revise Major
04 Sep 20201st Revision Received
16 Sep 2020Submission Checks Completed
16 Sep 2020Assigned to Editor
16 Sep 2020Reviewer(s) Assigned
20 Sep 2020Review(s) Completed, Editorial Evaluation Pending
20 Sep 2020Editorial Decision: Revise Minor
21 Sep 20202nd Revision Received