Robotic Device Makes History in Treating Severe Heart Failure

For the first time in United States medical history, surgeons at St. Luke’s-Roosevelt Hospital Center in New York City are using a robotic device to perform cardiac resynchronization therapy (CRT), a new pacemaker treatment designed to treat the two to three million Americans who suffer from severe heart failure and ventricular dysynchrony.

Cardiothoracic surgeons Joseph J. DeRose, Jr., MD and Robert C. Ashton, Jr., MD, together with cardiac electrophysiologists Frederick Ehlert, MD, Jonathan Steinberg, MD and Margot Vloka, MD performed the procedure, also known as biventricular pacing, using Intuitive Surgical, Inc.’s Da Vinci Surgical System. Da Vinci, which is FDA-approved for this type of procedure, is used in surgical programs worldwide.

Cardiac resynchronization therapy uses standard pacemaker technology, but with a special third lead to sense and pace the left ventricle. By using a third lead – a method recently deemed safe and effective by the Food and Drug Administration – the pacemaker provides outputs to both the left and right ventricles simultaneously to restore synchrony and allow the ventricles to pump more efficiently. The result is significant improvement of heart failure symptoms, including breathlessness, fatigue, and build-up of fluid that causes swelling, especially in the feet, ankles or legs.

Using traditional percutaneous methods typically used with pacemakers, this third lead is placed via the coronary sinus into a vein on the back of the heart. However, variations in individual anatomy, combined with the procedure’s technical challenges, make this vein inaccessible via standard percutaneous methods 15 to 20 percent of the time. The result for these patients with severe heart failure is an unsuccessful pacemaker implant. The Da Vinci robot allows surgeons to attach the third lead to the wall on the outside of the heart, to ensure successful implantation for all patients afflicted with severe heart disease.

“The ability to perform cardiac resynchronization therapy with robotic technology will have a great impact on the treatment of severe heart disease, especially the percent of the population who have an inaccessible cardiac vein for placement of the third lead,” said Dr. DeRose, director of robotics at St. Luke’s-Roosevelt Hospital Center. To date, the cardiothoracic robotic team of Drs. DeRose and Ashton has combined with Drs. Ehlert, Steinberg and Vloka to place epicardial pacemaker leads using the Da Vinci robot in five patients. One month later, all patients have well functioning leads and have reported improvements to their symptoms, demonstrating dramatic improvements to biventricular pacing.

How Robotic Technology Works
The Da Vinci Surgical System consists of two primary components: the surgeon’s viewing and control console and the surgical arm units that position and maneuver detachable and interchangeable surgical instruments. These pencil-sized instruments (with tiny, computer-enhanced mechanical wrists) are designed to provide the dexterity of the surgeon's forearm and wrist at the operative site through tiny entry ports of less than one centimeter. This technology enables the surgeon to enter the chest cavity and perform surgery without major incisions or separation of the sternum.

For more information, please call St. Luke’s-Roosevelt Hospital’s Center for Minimally Invasive Cardiothoracic Surgery at (212) 523-2717.