OBJECTIVE:We report our initial cases of robotic left atrial appendage occlusion (LAAO) device deployment. METHODS:From June 2021 to December 2024, all consecutive patients undergoing robotic-assisted LAAO (isolated or with robotic-assisted CABG) using an epicardial clip were enroled. The study protocol was approved by the Institutional Review Board (IRB 45CFR164.512). RESULTS:A total of 28 patients were included, 22 of which underwent a concomitant CABG. Transesophageal echocardiogram confirmed excellent exclusion of the LA appendage in all but one patient. There were no postoperative strokes, myocardial infarctions, reoperation for bleeding, unplanned revascularisation, or deaths. At a median of 1.4 [0.9-1.8] years, there was 1 non-cardiac mortality (cancer) and 1 stroke. Nine (32.1%) patients were off OAC, while 21 (75.0%) were off class I-III antiarrhythmic drugs. CONCLUSIONS:These early results show optimal stroke prevention outcomes, considering the high-risk level of the patients. Longer follow-up is warranted to confirm these outcomes.
Importance:Females with atrial fibrillation (AF) experience a higher risk of stroke, myocardial infarction, and mortality than males with AF. Theories suggest that sex-based differences in hormonal, structural, and electrophysiologic factors are associated with this imbalance; we hypothesized that sex-based differences in health care access and utilization (HCAU) are also underlying factors. Objective:To determine whether sex-based disparities in HCAU barriers exist among individuals with AF. Design, Setting, and Participants:This cross-sectional study used data on patients with AF in the All of Us Research Program Registered Tier dataset (version 8), which contains integrated data from the electronic health record and various health surveys between August 8, 2016, and October 1, 2023. Inclusion criteria were age 18 years or older, a SNOMED (Systematized Nomenclature of Medicine) diagnosis of AF, and completion of the Health Care Access and Utilization Survey. Exclusion criteria included lack of binary sex information. Data were extracted and analyzed between November 2025 and April 2026. Main Outcomes and Measures:Association between sex at birth and participant responses to 20 HCAU outcomes. Multivariable logistic regression and marginal standardization were used to calculate unadjusted and adjusted odds ratios, adjusted predicted probabilities (APPs), and adjusted risk differences (ARDs). Multiplicity was addressed using the Holm-Bonferroni method. Results:The 12 428 eligible participants had a median (IQR) age of 70 (63-75) years and included 6877 males (55.3%). Compared with males with AF, females with AF had significantly higher APPs of reporting HCAU barriers to 14 of 20 outcomes after adjusting for baseline differences in sociodemographic and clinical characteristics. The largest differences were observed in cost-related medication access and adherence behaviors and nervousness about seeing a health care practitioner. Females compared with males were more likely to report asking for a lower-cost medication (APP, 25.12% [95% CI, 23.92%-26.32%] vs 20.84% [95% CI, 19.82%-21.86%]; ARD, 4.28 [95% CI, 2.65-5.90] percentage points), being unable to afford prescription medications (APP, 12.77% [95% CI, 11.93%-13.61%] vs 9.20% [95% CI, 8.47%-9.93%]; ARD, 3.57 [95% CI, 2.42-4.72] percentage points), delaying prescription fills (APP, 11.20% [95% CI, 10.38%-12.01%] vs 7.81% [95% CI, 7.12%-8.50%]; ARD, 3.39 [95% CI, 2.29-4.48] percentage points), and being nervous about seeing a health care practitioner (APP, 9.35% [95% CI, 8.57%-10.14%] vs 6.18% [95% CI, 5.56%-6.80%]; ARD, 3.17 [95% CI, 2.14-4.21] percentage points). Conclusions and Relevance:In this cross-sectional study, females with AF reported a greater burden of HCAU barriers than males with AF. This finding may explain some of the observed differences in AF outcomes between sexes.
Objective In robotic-assisted coronary surgery, few programs use the robot to execute the complete procedure (totally endoscopic coronary artery bypass [TECAB]). We report lessons learned from >1,000 consecutive TECAB cases at our institution. Methods Retrospective review of 1,035 patients undergoing robotic beating-heart TECAB (7/2013-3/2026) by a single experienced surgeon. Patients were divided chronologically into four groups of 250 cases each. Perioperative outcomes were compared across eras. Results In the whole cohort (n=1,035), the mean STS predicted risk of mortality was 1.43±2.1%. Multivessel TECAB was performed in 54% of patients, of whom 87% received BITA grafting. Of 1676 total anastomoses, 35% were via an anastomotic device; 63% via robotic suturing. There was 1 intraoperative conversion (0.09%). Mean LOS was 2.26±0.9 days. There was 1 clinical myocardial infarction and 3 strokes. Hospital mortality was 0.67% (O/E 0.47). Early graft patency was 97%.Across eras, STS PROM decreased (p=0.006). Multivessel TECAB declined (61% to 47%, p=0.02), while operative time increased (251 to 294 min, p=0.002), coinciding with transition to robotic suturing from anastomotic devices (98% to 0%, p<0.001) and increased trainee involvement. Conversion remained rare (1 early case). Hospital LOS shortened (2.7 to 2.0 days, p<0.001); POAF decreased (18 to 8%, p=0.002). Early mortality and MACCE remained low with no temporal difference (p=0.384 and p=0.484, respectively). Among HCR patients, graft patency remained >96% across all eras (p=0.35). Conclusions In this series of 1,035 robotic beating-heart TECAB patients using the third-generation robot with an EndoWrist stabilizer, we demonstrate that the procedure can be performed with consistent, excellent results. These findings support the sustainability of TECAB with the evolution of new robotic systems with EndoWrist stabilization.
Objective Previous investigators have demonstrated the importance of social media in shaping public perceptions of the cardiothoracic surgical workforce, as well as the utility of online networking in providing support for women in this field. Beginning in 2012, the Women in Thoracic Surgery (WTS) embarked upon a targeted initiative to develop a social media presence, with the ultimate goal of disseminating key information to members of the specialty, inspiring potential future trainees, and dispelling myths regarding the definition of a cardiothoracic surgeon. These efforts aimed to specifically build professional networks, facilitate mentorship, and augment the visibility of individual surgeons and their work. After more than a decade of deliberate growth, we aimed to characterize the digital footprint of WTS over time across its breadth of social media platforms. Methods Using annual reports from 2012 to 2025, we retrospectively analyzed engagement metrics of all WTS social media accounts. Key metrics included follower counts on Facebook, X (formerly Twitter), Instagram, and YouTube, as well as engagement highlights and demographic trends. Results Facebook followers grew from <50 in 2012 to 3100 in 2025, with significant global engagement. X/Twitter engagement demonstrated the greatest growth trajectory, increasing from approximately 300 followers in 2014 to 7300 followers in 2025, driven by advocacy campaigns, collaborative TweetChats, and real-time event coverage. The WTS Instagram account, which launched in 2018, now has 3100 followers. The YouTube audience expanded from 6 to 55 subscribers between 2018 and 2022. Across these platforms, the audience was predominantly composed of women aged 25 to 44 years, with a wide global reach. The top 3 countries represented among followers were the United States, Egypt, and India. Facebook posts from the 3 most recent months averaged 251 views, 165 reach, 3.3 reactions, and 7.6 total clicks per post. Conclusions WTS social media outreach has demonstrated sustained and strategic growth across all major platforms. This evolution has enhanced the organization's ability to connect, educate, and advocate for women in cardiothoracic surgery. These results highlight the potential of online platforms to engage a global community and to connect women surgeons with peers, allies, collaborators, and role models.
