Minimally Invasive and Robotic Cardiothoracic Surgery
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Services and Treatments

Minimally Invasive and Robotic Cardiothoracic Surgery

Minimally invasive cardiothoracic surgical techniques are reducing the impact of traditional heart surgery and returning patients to their active lives more quickly. These techniques are also allowing patients who otherwise would have no options, the chance at surgical intervention and the hope of improved symptoms and a prolonged life expectancy.

Robotic technology is being applied at the Montefiore Einstein Center for Heart and Vascular Care to improve the accuracy and broaden the application of minimally invasive cardiothoracic surgery. The da Vinci® Robotic Surgical System, made by Intuitive Surgical Inc., utilizes small, precise operating instruments that simulate the motion of the human wrist. The instruments are placed through three small ports in the chest cavity and the surgeon controls the instruments at a separate operating console. Enhanced high-definition, three-dimensional vision, together with a scaled computer interface, allow for the highest degree of surgicalprecision.

Clinical Pioneers, Academic Leaders

Cardiac surgeons at the Heart and Vascular Center are experts in minimally invasive and robotic surgery, and lead the way in the development of this rapidly expanding and exciting field. Our surgeons have published more scientific papers, abstracts and book chapters on cardiothoracic robotics than any other institution in the region.

Dr. Robert Michler, Chairman of Montefiore's Cardiothoracic Surgery Department and co-Director of the Montefiore-Einstein Heart Center, was among the first surgeons in the Unites States to perform robotic heart surgery and his work expedited FDA approval of robotic mitral valve repair and coronary artery bypass surgery.

Dr. Joseph J. DeRose, Jr, Director of Minimally Invasive and Robotic Cardiac Surgery, has also pioneered the application of the Da Vinci Surgical Robot performing the first Robotic Biventricular Pacemaker in the world in 2002. Dr. DeRose likewise participated in the first robotic atrial septal defect closure in the United States and the first robotic thymectomy in the United States for Myasthenia Gravis. Dr. DeRose has appeared on NBC news, MSNBC, CBS news and the Today show discussing the merits of minimally invasive and robotic surgery. He has trained over 25 centers in the United States in robotic cardiothoracic surgery since 2002.

Robotic Coronary Artery Bypass Surgery
Conventional coronary bypass surgery (CABG) is typically performed by dividing the breastbone and stopping the heart. With the added precision of robotics, surgeons at the Montefiore Einstein Center for Heart and Vascular Care are now performing single and double coronary artery bypass surgery through 3-5cm incisions between the ribs while the heart still beats. For patients with more severe coronary artery disease, robotic CABG can be combined with percutaneous interventions to provide a minimally invasive hybrid revascularization. Both Dr. Michler and Dr. DeRose have pioneered the development of this procedure and have been performing this surgery since 2002.

Robotic Mitral Valve Surgery
Minimally invasive techniques are being used to perform mitral valve surgery through a small incision in between the ribs of the right chest cavity. With the use of robotics and video assistance, our surgeons are able to repair (instead of replace) over 75% of leaky mitral valves. This allows the patient to retain his or her own valve and frequently eliminates the need for blood thinners. By avoiding division of the breastbone, the minimally invasive approach results in early ambulation and return to full activity within 7-10 days of surgery. Dr. Michler participated in the earliest trials of robotic mitral valve repair which led to FDA approval of the device and Dr. DeRose has been performing this operation since 2001.

Robotic Atrial Septal Defect Closure
An atrial septal defect is a hole in the heart that can cause mixing of blue and red blood and lead to poor oxygenation and heart failure. Together with the Pediatric Cardiology Division at the Children's Hospital at Montefiore, the minimally invasive cardiac surgical team offers the full range of therapies for this condition. Small holes can be closed with devices that can be inserted with small catheters through the groin whereas larger holes are repaired with the robot through 4 small ports in the right chest cavity.

Robotic Biventricular Pacemaker Insertion
Biventricular pacing is a therapy to treat heart failure in patients with altered electrical conduction. Although conventional pacemakers are inserted through a vein under the clavicle, biventricular pacemakers require the placement of pacing leads on both the right and left side of the heart. Dr. DeRose has pioneered a technique in which the robot is used to map the heart and place the left sided lead in exactly the right position for optimal "resynchronization." Dr. DeRose performed the first robotic biventricular pacemaker insertion in the world and he has the largest experience with this procedure worldwide. He is also the primary investigator of a clinical study being conducted at Montefiore Medical Center comparing robotic and conventional biventricular pacemaker insertion.

Transcatheter Aortic Valve Replacement
TAVR (Transcatheter Aortic Valve Replacement ) is the procedure in which a replacement aortic valve is threaded through a catheter and placed into position within the heart. If conventional valve repair or replacement is not an option for a patient with severe aortic stenosis, the TAVR procedure was approved by federal regulators last November and is now available at Montefiore. During TAVR, a bioprosthetic valve is threaded through the femoral artery via a catheter and then into the heart. Once in position, balloon valvuloplasty is performed to deploy the replacement valve and its frame within the diseased native aortic valve. The procedure is performed in a hybrid catheterization lab and, once perfected, often takes less than an hour. Montefiore Medical Center is among the first wave of sites selected nationwide to launch a TAVR program in 2012. Patients are actively being evaluated for inclusion in Montefiore’s TAVR program. For additional information about the program, visit www.montefiore.org/tavr or call 718-920-7000.

Robotic Atrial Fibrillation Surgery
Atrial fibrillation is an irregular, rapid heart rhythm that can result in shortness of breath as well as blood clot formation and stroke. Although many patients are treated with medications and blood thinners, some patients are candidates for an ablation, thereby eliminating the electrical pathways that cause this condition. Robotic techniques allow surgeons at the Heart and Vascular Center to perform a wide array of minimally invasive endoscopic techniques aimed at treating the electrical cause of atrial fibrillation in each individual patient.

Robotic Thymectomy
Patients with an autoimmune condition known as myasthenia gravis suffer from weakness of muscles including muscles of the face, eyes and throat. Many of these patients are young women with severe muscle weakness. A standard treatment for such patients frequently includes removal of the fatty tissue underneath the breastbone, known as the thymus gland.

Montefiore uses robotic surgery to perform this operation through three small ports in the right chest, thereby eliminating the need to divide the breastbone. The robotic procedure has made possible early hospital discharge and return to activity for these patients with an excellent cosmetic result. Dr. DeRose participated in the first robotic thymectomy in the United States and has helped to pioneer the procedure.