"First-in-human" totally robotic orthotopic heart transplant.

IMPORTANCE

Traditionally, heart transplantation surgery requires a median sternotomy due to the perceived complexity of a large organ replacement. Whether an alternative minimally invasive approach to perform a successful heart transplant can be accomplished remains uncertain.

OBJECTIVE

To develop a safe and effective technique for totally robotic heart transplantation.

DESIGN

Using a multidisciplinary team, technical timed training using the robot-assisted approach was accomplished on multiple cadavers. Importantly, practice to limit the donor organ ischemic time to ensure patient safety was deemed essential, and once readiness was achieved, an in-vivo operation was undertaken.

SETTING

Academic cardiac surgical unit of King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia).

PARTICIPANT: A 16-year-old boy with refractory biventricular heart failure caused by a nonischemic dilated cardiomyopathy MAIN OUTCOME: A successful totally robotic heart transplant, with a short ischemic time, mechanical ventilation <24 hours, rapid patient mobilization, and reduced postoperative pain and hospital duration of stay.