BACKGROUND: European surgeons were the first worldwide to use robotic techniques in cardiac surgery and major steps in procedure development were taken in Europe. After a hype in the early 2000s case numbers decreased but due to technological improvements renewed interest can be noted. We assessed the current activities and outcomes in robotically assisted cardiac surgery on the European continent. METHODS: Data were collected in an international anonymized registry of 26 European centers with a robotic cardiac surgery program. RESULTS: During a 4-year period (2016-2019), 2,563 procedures were carried out [30.0% female, 58.5 (15.4) years old, EuroSCORE II 1.56 (1.74)], including robotically assisted coronary bypass grafting (n = 1266, 49.4%), robotic mitral or tricuspid valve surgery (n = 945, 36.9%), isolated atrial septal defect closure (n = 225, 8.8%), left atrial myxoma resection (n = 54, 2.1%), and other procedures (n = 73, 2.8%). The number of procedures doubled during the study period (from n = 435 in 2016 to n = 923 in 2019). The mean cardiopulmonary bypass time in pump assisted cases was 148.6 (63.5) min and the myocardial ischemic time was 88.7 (46.1) min. Conversion to larger thoracic incisions was required in 56 cases (2.2%). Perioperative rates of revision for bleeding, stroke, and mortality were 56 (2.2%), 6 (0.2 %), and 27 (1.1%), respectively. Median postoperative hospital length of stay was 6.6 (6.6) days. CONCLUSION: Robotic cardiac surgery case numbers in Europe are growing fast, including a large spectrum of procedures. Conversion rates are low and clinical outcomes are favorable, indicating safe conduct of these high-tech minimally invasive procedures.

Acibadem Maslak Hospital Acibadem University Istanbul Turkey

AZ Maria Middelares Ghent Belgium

Central Teaching Hospital of the Ministry of the Interior and Administration Centre of Postgraduate Medical Education Warsaw Poland

CHU Dijon Dijon France

CHU UCL Namur Site Godinne Namur Belgium

Cliniques Univesitaires Saint Luc Brussels Belgium

Department of Cardiovascular Sciences University Hospital Leuven KU Leuven Leuven Belgium

Erasme Hospital Brussels Brussels Belgium

Gulhane Education ve Research Hospital Ankara Turkey

Henri MONDOR Hospital Assitance Publique Hopitaux de Paris Paris France

Hospital Clínic de Barcelona Barcelona Spain

Humanita Gavazzeni Bergamo Italy

Imelda Hospital Bonheiden Bonheiden Belgium

ISALA Hospital Zwolle Netherlands

Istanbul Mehmet Akif Ersoy Cardiovascular Surgery Hospital University of Health Sciences Istanbul Turkey

Leiden University Medical Center Leiden Netherlands

Liverpool Heart and Chest Liverpool United Kingdom

Maastricht University Medical Center Maastricht Netherlands

MONZA Hospital Bucharest Romania

Na Homolce Hospital Prague Czechia

OLV Ziekenhuis Aalst Belgium

Robert Bosch Hospital Stuttgart Germany

Rouen University Hospital Rouen France

San Camillo Hospital Rome Italy

University Hospital Bordeaux Bordeaux France

University Hospital Ghent Ghent Belgium

University Hospital Hradec Kralove Hradec Kralove Czechia

University Hospital Zurich Zurich Switzerland

University Medical Centre Utrecht Utrecht Netherlands

University of Pittsburgh Medical Center Pittsburgh PA United States

Ziekenhuis Oost Limburg Genk Belgium

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Front Cardiovasc Med. 2022 Mar 07;9:870390. doi: 10.3389/fcvm.2022.870390. PubMed

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Loulmet F, Carpentier A, d'Attellis N, Berrebi A, Cardon C, Ponzio O, et al. . Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments. J Thorac Cardiovasc Surg. (1999) 118:4–10. 10.1016/S0022-5223(99)70133-9 PubMed DOI

Carpentier A, Loulmet D, Aupecle B, Kieffer JP, Tournay D, Guibourt P, et al. . Computer assisted open heart surgery. First case operated on with success C R. Acad Sci III. (1998) 321:437–42. 10.1016/S0764-4469(98)80309-0 PubMed DOI

Mohr FW, Falk V, Diegeler A, Walther T, Gummert JF, Bucerius J, et al. . Computer-enhanced “robotic” cardiac surgery: experience in 148 patients. J Thorac Cardiovasc Surg. (2001) 121:842–53. 10.1067/mtc.2001.112625 PubMed DOI

Kappert U, Cichon R, Schneider J, Gulielmos V, Tugtekin SM, Matschke K, et al. . Closed-chest coronary artery surgery on the beating heart with the use of a robotic system. J Thorac Cardiovasc Surg. (2000) 120:809–11. 10.1067/mtc.2000.109543 PubMed DOI

Bonatti J, Bonaros N, Mueller S, Bartel T. Completely endoscopic removal of a dislocated Amplatzer atrial septal defect closure device. Interact Cardiovasc Thorac Surg. (2008) 7:130–32. 10.1510/icvts.2007.164517 PubMed DOI

Bonatti J, Schachner T, Bonaros N, Laufer G, Kolbitsch C, Margreiter J, et al. . Robotic totally endoscopic coronary artery bypass and catheter based coronary intervention in one operative session. Ann Thorac Surg. (2005) 79:2138–41. 10.1016/j.athoracsur.2003.12.074 PubMed DOI

Loulmet D, Koeckert M, Neuburger P, Nampiaparampil R, Grossi E. Robotic mitral repair for Barlow's disease with bileaflet prolapse and annular calcification using pericardial patch technique. Ann Cardiothorac Surg. (2017) 6:67–9. 10.21037/acs.2017.01.09 PubMed DOI PMC

Bonatti J, Wehman B, de Biasi A, Jeudy J, Griffith B, Lehr E. Totally endoscopic quadruple coronary artery bypass grafting is feasible using robotic technology. Ann Thorac Surg. (2012) 93:111–12. 10.1016/j.athoracsur.2011.11.049 PubMed DOI

Pettinari M, Navarra E, Noirhomme P, Guttermann H. The state of robotic cardiac surgery in Europe. Ann Cardiothorac Surg. (2017) 6:1–6. 10.21037/acs.2017.01.02 PubMed DOI PMC

Bonatti J, Wallner S, Crailsheim I, Grabenwoger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting – a 25-year review. J Thorac Dis. (2021) 13:1922–44. 10.21037/jtd-20-1535 PubMed DOI PMC

Cavallaro P, Rhee A, Chiang Y, Itagaki S, Seigerman M, Chikwe J. In-Hospital mortality and morbidity after robotic coronary artery surgery. J Cardiothorac Vasc Anesth. (2015) 29:27–31. 10.1053/j.jvca.2014.03.009 PubMed DOI

Thijs I, Fresiello L, Oosterlinck W, Sinnaeve P, Rega F. Assessment of physical activity by wearable technology during rehabilitation after cardiac surgery: explorative prospective monocentric observational cohort study. JMIR Mhealth Uhealth. (2019) 7:e9865. 10.2196/mhealth.9865 PubMed DOI PMC

Nifong L, Rodriguez E, Chitwood W. 540 consecutive robotic mitral valve repairs including concomitant atrial fibrillation cryoablation. Ann Thorac Surg. (2012) 94:38–43. 10.1016/j.athoracsur.2011.11.036 PubMed DOI

Murphy DA, Moss E, Binongo J, Miller JS, Macheers SK, Sarin EL, et al. . The expanding role of endoscopic robotics in mitral valve surgery: 1257 consecutive procedures. Ann Thorac Surg. (2015) 100:1675–81. 10.1016/j.athoracsur.2015.05.068 PubMed DOI

Gillinov AM, Mihaljevic T, Javadikasgari H, Suri RM, Mick SL, Navia JL, et al. . Early results of robotically assisted mitral valve surgery: analysis of the first 1000 cases. J Thorac Cardiovasc Surg. (2018) 155:82–91. 10.1016/j.jtcvs.2017.07.037 PubMed DOI

Gammie J, Zhao Y, Peterson E, O'Brien S, Rankin S, Griffith B. Less-invasive mitral valve operations: trends and outcomes from the society of thoracic surgeons adult cardiac surgery database. Ann Thorac Surg. (2010) 90:1401–10. 10.1016/j.athoracsur.2010.05.055 PubMed DOI

Kuo CC, Chang HH, Hsing CH Hii HP, Wu NC, Hsu CM, et al. . Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital. Eur J Cardiothorac Surg. (2018) 54:853–59. 10.1093/ejcts/ezy134 PubMed DOI PMC

Toracca L, Ismeno G, Quarti A, Alfieri O. Totally endoscopic atrial septal defect closure with a robotic system: experience with seven cases. Heart Surg Forum. (2002) 5:125–27. PubMed

Wimmer-Greinecker G, Dogan S, Tayfun-Aybek T, Khan MF, Mierdl S, Bayhahn C, et al. . Totally endoscopic atrial septal repair in adults with computer enhanced telemanipulation. J Thorac Cardiovasc Surg. (2003) 126:465–8. 10.1016/S0022-5223(03)00053-9 PubMed DOI

Argenziano M, Oz M, Kohmoto T, Morgan J, Dimitui J, Mongero L, et al. . Totally endoscopic atrial septal defect repair with robotic assistance. Circulation. (2003) 108:II191–94. 10.1161/01.cir.0000089043.82199.2f PubMed DOI

Bonaros N, Schachner T, Oehlinger A, Ruetzler E, Kolbitsch C, Dichtl W, et al. . Robotically assisted totally endoscopic atrial septal defect repair: insights from operative times, learning curves, and clinical outcome. Ann Thorac Surg. (2006) 82:687–94. 10.1016/j.athoracsur.2006.03.024 PubMed DOI

Kadirogullari E, Onan B, Timur B, Birant A. Reyhancan et al.: Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure: a single-center experience. J Card Surg. (2020) 35:764–71. 10.1111/jocs.14456 PubMed DOI

Schilling J, Engel AM, Hassan M, Smith JM. Robotic excision of atrial myxoma. J Card Surg. (2012) 27:423–26. 10.1111/j.1540-8191.2012.01478.x PubMed DOI

Jansens JL, Jottrand M, Preumont N, Stoupel E, De Canniere D. Robotic-enhanced biventricular resynchronization: an alternative to endovenous cardiac resynchronization therapy in chronic heart failure. Ann Thorac Surg. (2003) 76:413–17. 10.1016/S0003-4975(03)00435-1 PubMed DOI

Bhatt AG, Steinberg JS. Robotic-assisted left ventricular lead placement. Heart Fail Clin. (2017) 13:93–103. 10.1016/j.hfc.2016.07.008 PubMed DOI

Schill MR, Sinn LA, Greenberg JW, Henn MC, Lancaster TS, Schuessler RB, et al. . A minimally invasive stand-alone Cox-Maze procedure is as effective as median sternotomy approach. Innovations. (2017) 12:186–91. 10.1177/155698451701200304 PubMed DOI PMC

Rodriguez E, Cook RC, Chu MWA, Chitwood WR. Minimally invasive bi-atrial cryomaze operation for atrial fibrillation. Oper Tech Thorac Cardiovasc Surg. (2009) 14:208–23. 10.1053/j.optechstcvs.2009.06.009 DOI

Van den Eynde J, Melly L, Torregrossa G, Oosterlinck W. Robotic cardiac surgery: what the young surgeon should know. Braz J Cardiovasc Surg. (2020) 35:6–8. 10.21470/1678-9741-2020-0437 PubMed DOI PMC

Valdis M, Chu MW, Schlachta C, Kiaii B. Evaluation of robotic cardiac surgery simulation training: a randomized controlled trial. J Thorac Cardiovasc Surg. (2016) 151:1498–505.e2. 10.1016/j.jtcvs.2016.02.016 PubMed DOI

Barbash GI, Glied SA. New technology and health care costs–the case of robot-assisted surgery. N Engl J Med. (2010) 363:701–4. 10.1056/NEJMp1006602 PubMed DOI

Morgan JA, Thornton BA, Peacock JC, Hollingsworth KW, Smith CR, Oz MC, et al. . Does robotic technology make minimally invasive cardiac surgery too expensive? A hospital cost analysis of robotic and conventional techniques. J Card Surg. (2005) 20:246–51. 10.1111/j.1540-8191.2005.200385.x PubMed DOI

How to advance from minimally invasive coronary artery bypass grafting to totally endoscopic coronary bypass grafting: challenges in Europe versus United States of America

Simulation-based assessment of robotic cardiac surgery skills: An international multicenter, cross-specialty trial

Current state of the art and recommendations in robotic mitral valve surgery

Robotic coronary revascularization in Europe, state of art and future of EACTS-endorsed Robotic Cardiothoracic Surgery Taskforce

Robot-assisted vs. conventional MIDCAB: A propensity-matched analysis