The multidisciplinary team at WVU Medicine’s WVU Heart and Vascular Institute (Morgantown, USA) has performed a pioneering robotic heart operation, combining valve replacement and coronary artery bypass operations.
This recent surgical advancement follows a related procedure conducted in January 2020, when the same WVU Robotic Cardiac Program surgical team performed the first robotic aortic valve replacement operation (RAVR) via a similar tiny incision through the ribs in a patient’s right chest near the axilla, or armpit.
“Patients who have both valve disease and coronary artery disease have traditionally been treated by open-heart surgery performed through the breast bone,” Lawrence Wei, professor in the WVU Department of Cardiovascular and Thoracic Surgery, and one of the WVU Heart & Vascular Institute team members that helped to develop the novel approach, said.
“Until now, the main exclusion for us to perform a robotic approach has been the coexistence of valve and coronary artery disease. Building on our experience with robotic aortic valve surgery, this new approach may help us extend robotic surgery options to many more patients,” Goya Raikar, assistant professor in the WVU Department of Cardiovascular and Thoracic Surgery and member of the robotic team, noted.
Historically, robotic heart surgery has been performed on otherwise lower risk patients with a single heart problem in need of repair, such as the mitral valve. Since 2017, the team at WVU has helped to pioneer thoughtful use of robotic technology that can be applied to more complex patients, reducing the risk of complications and improving outcomes of heart surgery. The RAVR procedure developed at WVU is one example of an advancement in robotic surgery that is now performed in multiple institutions in several countries around the world.
A press release from WVU details the problems faced by Poppy McGee, 73, the first patient to have undergone the combined the procedure. Following a stroke, brain surgery, and ongoing weight loss, McGee had become quite frail. When informed that she had both a severe problem with her aortic valve and a significant blockage in her coronary artery causing her heart to fail, she and her family feared she would not be able to tolerate conventional open-heart surgery.
McGee’s cardiologists subsequently referred her to Vinay Badhwar, executive chair of the WVU Heart & Vascular Institute and professor and chairman of the Department of the WVU Department of Cardiovascular and Thoracic Surgery. Badhwar first offered McGee conventional open-heart surgery, which in her case would have proven risky. Badhwar told McGee and her family she had just over a 10% chance of dying and close to a 50% chance of complications.
After discussing the risks with McGee and considering her family’s request for a potentially less invasive or robotic approach, Badhwar explained that while his team had developed a new robotically performed technique to treat cases just like hers, she would be the first in the world to undergo such a procedure. McGee and her family understood the risks involved but quickly agreed.
On 31 October 2024, McGee became the world’s first patient to undergo both an aortic valve replacement and coronary artery bypass grafting, all through a single small incision on the far right side of her chest, performed completely robotically. Not only was the surgery a technical success, but her heart’s beat function improved after the operation.
“It is such an honour and privilege to work alongside the excellent WVU Robotic Cardiac Program team at the WVU Heart and Vascular Institute. Their teamwork has enabled several innovations in robotic cardiac surgery, such as the one we used to help Ms McGee,” Badhwar said.
“While we are still in the early days of this latest innovation, the ability to perform valve surgery and coronary artery bypass surgery fully robotically through a single incision has the potential to open up a new era of robotic heart surgery. We must always keep quality outcomes at the forefront of all innovation. However, if surgeons adopt and gain experience with techniques such as this one, they will tackle this last frontier that previously limited a robotic approach. One day in the near future, this may serve as a platform to perform nearly all types of heart surgery.”
