EACTS Expert Consensus Document on Robotic Cardiac Surgery Minimum Standards for Programme Implementation, Training and Quality Assurance, developed in collaboration with EACTAIC and EBCP
European Journal of Cardio-Thoracic Surgery, vol. 68
Abstract
Robotic cardiac surgery is entering a renewed phase of adoption, supported by growing clinical experience, evolving robotic platforms, and rising demand for less invasive procedures and faster recovery. However, implementation remains technically demanding and resource-intensive and can expose patients to avoidable harm when initiated without a structured training programme, clear technical standards, and rigorous outcome monitoring. This expert consensus document summarizes the current state of robotic cardiac surgery and defines requirements for the safe, effective, and sustainable development of robotic cardiac programmes. It addresses the current regulatory environment for surgical robots and accessories and proposes minimum requirements for hardware, software, and instruments for reconstructive intracardiac and coronary cardiac procedures. Furthermore, it outlines prerequisites for starting and developing training centres, including surgeon experience, multidisciplinary team composition, patient selection, and institutional infrastructure and volume considerations. A stepwise, competency-based training pathway is presented that integrates video and live case observation, virtual and simulation-based skills acquisition, wet/dry laboratory training, and proctored clinical implementation, ideally supported by dual-console systems. The document emphasises the need for transparent documentation and outcome benchmarking via a society-driven database to support quality assurance, learning-curve oversight, and continuous improvement. Finally, it highlights priorities for further research, including harmonized reporting standards, long-term and procedure-specific outcome evaluation, and prospective studies assessing training models, cost-effectiveness, and the incremental value of emerging technologies.
Authors 32
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Affiliation as printed
Department of Cardiovascular Sciences, Research Unit of Cardiac Surgery, KULeuven , Leuven,
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Leiden University Medical Center
Affiliation as printed
Department of Cardiothoracic Surgery, Leiden University Medical Center , Leiden,
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Affiliation as printed
Department of Cardiothoracic Surgery, Heart and Lungs Division, UMC Utrecht , Utrecht,
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University of Zurich · University Hospital Zurich · National Heart, Lung, and Blood Institute
Affiliation as printed
Department of Cardiac Surgery and Center of Excellence, National Institute for Heart and Blood Vessels Dedinje , Belgrade,
Department of Cardiac Surgery, University Hospital Zurich, University of Zurich , Zurich,
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Affiliation as printed
Department of Cardiovascular Sciences, Research Unit of Cardiac Surgery, KULeuven , Leuven,
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University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Hospital Freiburg , Freiburg,
Faculty of Medicine, University of Freiburg , Freiburg,
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Affiliation as printed
Department of Cardiac Surgery, Heart Center Azorg , Aalst,
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Universitair Ziekenhuis Leuven
Affiliation as printed
Department of Cardiac Surgery, University Hospitals Leuven , Leuven,
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ETH Zurich · Deutsches Herzzentrum der Charité · German Centre for Cardiovascular Research
Affiliation as printed
DZHK (German Center for Cardiovascular Research) partner site , Berlin,
Deutsches Herzzentrum der Charité, Charité University Medicine Berlin , Berlin,
Swiss Federal Institute of Technology, Department of Health Science and Technology , Zurich,
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Centre Hospitalier Universitaire Henri-Mondor · Assistance Publique – Hôpitaux de Paris · Hôpitaux Universitaires Henri-Mondor
Affiliation as printed
Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris , Creteil,
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University of Freiburg · University Medical Center Freiburg
Affiliation as printed
Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Hospital Freiburg , Freiburg,
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Affiliation as printed
Department of Cardiovascular Surgery, Motol and Homolka University Hospital – Campus Motol , Prague,
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Affiliation as printed
Department of Anaesthesiology, University Hospitals of Leuven , Leuven,
Department of Cardiovascular Sciences, KU Leuven , Leuven,
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Deutsches Herzzentrum der Charité · German Centre for Cardiovascular Research
Affiliation as printed
DZHK (German Center for Cardiovascular Research) partner site , Berlin,
Deutsches Herzzentrum der Charité, Charité University Medicine Berlin , Berlin,
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Affiliation as printed
Department of Perioperative Medicine, Barts Heart Centre , London,
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COPE Galway · Trials Methodology Research Network · Clinical Science Institute
Affiliation as printed
Institute for Clinical Trials, University of Galway , Galway,
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Hospital Sant Joan de Déu Barcelona · Centro de Investigación en Red en Enfermedades Cardiovasculares · Centro de Investigación Biomédica en Red · Hospital Clínic de Barcelona
Affiliation as printed
Center for Congenital Heart Disease, Hospital Sant Joan de Déu , Barcelona,
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) , Madrid,
Department of Cardiovascular Surgery, Hospital Clínic , Barcelona,
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Affiliation as printed
European Association for Cardio-Thoracic Surgery (EACTS) , Windsor,
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Hospital Clínic de Barcelona · Consorci Institut D'Investigacions Biomediques August Pi I Sunyer
Affiliation as printed
Anesthesia Department, Hospital Clinic , Barcelona,
Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona,
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Affiliation as printed
Robot-Assisted Surgery Group, Department of Mechanical Engineering, KU Leuven , Leuven,
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Affiliation as printed
Department of Cardiothoracic Surgery, University of Pittsburgh , Pittsburgh, PA,
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Affiliation as printed
Department of Cardiovascular Surgery, Motol and Homolka University Hospital – Campus Motol , Prague,