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Establishing A Comprehensive Adult And Pediatric Robotic Congenital Cardiac Surgery Program
Madonna E. Lee, MD1, Andrea Amabile, MD1, Heid Boules, MD2, Michael LaLonde, MHA, PA-C3, Tyler Wahl, MHS, CCP, LP3, Isaac Hammond, Jr., PA-C3, Markus Krane, MD1, Arnar Geirsson, MD1, Peter J. Gruber, MD, PhD1.
1Department of Surgery, Yale School of Medicine, New Haven, CT, USA, 2Department of Anesthesia, Yale School of Medicine, New Haven, CT, USA, 3Yale New Haven Hospital, New Haven, CT, USA.

Objective(s): Describe the development and evolution of a robotic congenital cardiac surgical program with an emphasis on technical aspects unique to pediatric patients.
Methods: We performed a single-center retrospective study including consecutive patients undergoing totally endoscopic robotic congenital cardiac operations from 01/2020 to 05/2023.
Results: Seventeen patients met inclusion criteria: 41.2% (n=7) male; and 58.8% (n=10) female. Average age was 27 (range, 7-71) years; mean weight 60.2 (range, 20.5-111.6) kg. The most common diagnosis was mitral valve (MV) insufficiency (n=8), followed by atrial septal defect/patent foramen ovale (ASD/PFO, n=7). The underlying etiologies ranged from rheumatic disease, parachute MV, and previously repaired complete atrioventricular septal defect. Other congenital lesions included dextrocardia and ventricular septal defect. The most common operations were ASD/PFO closure (n=6), MV repair (n=4) and MV replacement (n=4, mechanical). Aortic cross-clamp techniques included Chitwood clamp 50% and endoaortic balloon occlusion 50% (n=8, each). There was one conversion to sternotomy. Mean hospital length-of-stay was 5.5 days. Post-operative complications included 4 pneumothoraces managed conservatively and 1 new-onset atrial fibrillation. One patient developed complete heart block needing temporary pacing, hemothorax requiring chest tube, and stroke. Two patients were readmitted within 30-days. All were alive at last follow-up. Specific perfusion and operative strategies were necessary to accommodate a spectrum of pathology and patient sizes.
Conclusions: The combination of adult robotic cardiac surgery experience with specific pediatric cardiac surgical expertise allowed the establishment of a safe, successful, minimally invasive robotic congenital cardiac surgical program to treat both children and adults.


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