Permanent Pacemaker Implantation After Minimally Invasive Robotic Cardiac Surgery and Long-Term Pacemaker Dependence Rates

BACKGROUND: The role of minimally invasive robotic heart surgery in the surgical field is swiftly expanding due to technological advancements and the acknowledgment that its safety is comparable to conventional cardiac surgery. The aim of this study was to evaluate permanent pacemaker (PPM) implantation rates, associated perioperative determinants, and the course of pacing rates during follow-up in a single-center cohort undergoing minimally invasive robotic cardiac surgery. METHODS: This retrospective study was conducted on 276 patients who received robotic heart surgery utilizing the da Vinci Si HD surgical system (Intuitive Surgical, Inc.) at the center. Patients were categorized into 2 groups: those who had PPM implantation post-surgery and those who did not. The general demographic data of patients, comorbidities, and intraoperative variables were retrospectively analyzed. RESULTS: Permanent pacemakers were implanted in 5.4% (n = 15) of patients after robotic cardiac surgery. Patients had an average age of 53.50 (±16.15) years. Age, gender, and comorbidities were similar between groups. Patients who received PPM implantation had substantially longer cardiopulmonary bypass (CPB) times (median = 210) than those who did not (median = 150) (P = .035). Additionally, the distribution of surgical types showed a significant difference according to PPM implantation status (P = .033), and mitral-tricus-pid valve surgery was observed at a higher rate in the PPM group (40.0% vs. 10.3%). CONCLUSION: This study shows that prolonged CPB duration and concurrent mitral-tricuspid valve surgery elevate the risk of PPM implantation in patients undergoing minimally invasive robotic heart surgery; furthermore, patients needing pacemaker implantation showed significant long-term pacing burden during follow-up.