Pioneering Robotic Cardiac Surgeon Johannes Bonatti, MD, Joins UPMC Heart and Vascular Institute

Cardiac surgeon Johannes Bonatti, MD, joined the UPMC Heart and Vascular Institute (HVI) on May 1. Dr. Bonatti is an internationally respected authority and pioneering figure in the use of robotic surgical technologies for cardiothoracic surgery, notably totally endoscopic coronary artery bypass and mitral valve repair.

Dr. Bonatti comes to the UPMC Heart and Vascular Institute after his most recent appointment at the Vienna Health Network in Vienna, Austria. Prior to his work in Austria, Dr. Bonatti was the Chief of the Department of Cardiothoracic Surgery at the Cleveland Clinic Abu Dhabi, a post he held from 2012 to 2015. From 2015 to 2018, Dr. Bonatti served as the Chairman of the Heart & Vascular Institute at Cleveland Clinic Abu Dhabi. He also was a Professor of Surgery at the Lerner College of Medicine at Case Western Reserve University and a cardiac surgeon at the main campus of the Cleveland Clinic in Ohio. Earlier in his career, Dr. Bonatti was a professor of surgery and the Director of Coronary Surgery and Advanced Coronary Interventions at the University of Maryland.

Expanding the UPMC HVI Robotic Surgery Program and Simulation Lab Training

Dr. Bonatti will direct the clinical and research efforts of the UPMC HVI robotic cardiac surgery program, expanding the institute’s capabilities in robotic cardiac surgery while working to study outcomes and develop new applications, approaches, and indications for robotically-assisted procedures. Dr. Bonatti also will work in the UPMC robotic surgery simulation lab to develop structured training programs, conduct procedural training for students and surgeons, and further his research aims related to advancing and expanding the discipline of robotic cardiac surgery. Simulation-based training and study on dry-lab and wet-lab models are crucial to developing robotic surgical skills, and UPMC has extensive capabilities on the simulation front for training and research.

As with all robotically-assisted surgery, the technology is highly advanced and allows for a fully immersive visual field with better acuity and the ability to manipulate the instrumentation in highly complex ways and more precise control than human hands can accomplish on their own. 

“However, robotically assisted cardiac surgery is still a rather nascent surgical modality when you compare it to traditional approaches. Tremendous strides have been made in its application across disciplines to the great benefit of patients, but there is so much yet to learn and accomplish, particularly in the field of cardiothoracic surgery," says Dr. Bonatti. "I am excited to continue my clinical and research work at UPMC, bringing the benefits of robotic-assisted surgery to our patients, expanding our program's capabilities, training new generations of surgeons, and contributing to the growing evidence base for its application."

Clinical and Research Interests

Dr. Bonatti's primary clinical and research interests revolve around minimally invasive and robotic cardiac surgery. He has performed more than 5,000 cardiac surgery cases to date, with close to 1,000 of those procedures conducted on robotic platforms. His work with robotic surgical platforms dates to the very earliest emergence of the technology in 2001 while he was practicing in Austria at the Innsbruck Medical University, and then at the University of Maryland, where he led a team charged with developing totally endoscopic approaches to coronary bypass surgery.

This pioneering work led to Dr. Bonatti and colleagues performing the world’s first robotic totally endoscopic triple and quadruple coronary artery bypass procedures (TECAB) in 2010 and 2012, respectively. Dr. Bonatti also was the first surgeon to perform a simultaneous hybrid coronary intervention using totally endoscopic bypass and drug-eluting stents.

“An  important advantage of the robotic endoscopic approach is a significant reduction in surgical trauma to the patient. Recovery periods are shortened considerably for these cases when comparing them to open procedures using a midline incision,” says Dr. Bonatti. “Perhaps most importantly, outcomes are comparable showing that robotic endoscopic approaches are safe, efficacious, and well-tolerated by patients.”

From a research perspective, one of Dr. Bonatti's goals is to make cardiac surgical procedures, regardless of the type, as endoscopic as possible. He is also interested in testing emerging robotic surgical technologies and platforms and applying them to ever-wider surgical indications.

"Developing standardized training pathways and objective measures of a surgeon's proficiency in robotic and endoscopic techniques is of great interest, and I will be continuing my efforts along these lines, including my work on leading a task force on robotic surgery with the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS)," says Dr. Bonatti.

Training and Mentorship in Cardiac Surgery

Training and mentoring cardiac surgeons on robotic platforms and techniques is a significant part of Dr. Bonatti's clinical and research work. In the past, he has been the President of the Minimally Invasive Robotics Association (MIRA) and President of ISMICS.

Further Reading

A selection of recently published research from Dr. Bonatti includes:

• Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally Invasive and Robotic Coronary Artery Bypass Grafting- A 25-Year Review. J Thorac Dis. 2021 Mar; 13(3): 1922-1944.
• Bonatti J, Crailsheim I, Grabenwöger M, Winkler B. Minimally Invasive and Robotic Mitral Valve Surgery – Methods and Outcome in a 20-Year Review. Innovations. 2021; In Press.
• Calafiore AM, Di Mauro M, Bonatti J, Centofanti P, Di Eusanio M, Faggian G, Fattouch K, Gaudino M, Kofidis T, Lorusso R, Menicanti L, Prapas S, Sarkar K, Stefano P, Tabata M, Zenati M, Paparella D. An Observational, Prospective Study on Surgical Treatment of Secondary Mitral Regurgitation: The SMR Study. Rationale, Purposes, and Protocol. J Card Surg. 2020 Oct; 35(10): 2489-2494.
• Bonatti J, Wallner S, Winkler B, Grabenwöger M. Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Current Status And Future Prospects. Expert Rev Med Devices. 2020 Jan; 17(1): 33-40.
• Göbölös L, Ramahi J, Obeso A, Bartel T, Hogan M, Traina M, Edris A, Hasan F, Banna ME, Tuzcu EM, Bonatti J. Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Systematic Review of Clinical Outcomes from the Past two Decades. Innovations (Phila). 2019 Feb; 14(1): 5-16.
• Bonatti J, Göbölös L, Ramahi J, Bartel T. Robotic Totally Endoscopic Coronary Artery Bypass Grafting (TECAB) of the Left Anterior Descending and Right Coronary Artery System Using an Arterial Y-Graft Technique. Ann Cardiothorac Surg. 2018 Sep; 7(5): 700-703.
• Pasrija C, Kon ZN, Ghoreishi M, Lehr EJ, Gammie JS, Griffith BP, Bonatti J, Taylor BS. Cost and Outcome of Minimally Invasive Techniques for Coronary Surgery Using Robotic Technology. Innovations (Phila). 2018 Jul/Aug; 13(4): 282-286.
• Stastny L, Kofler M, Dumfarth J, Basaran A, Wiedemann D, Schachner T, Feuchtner G, Bonatti J, Bonaros N. Long-Term Clinical and Computed Tomography Angiographic Follow-up After Totally Endoscopic Coronary Artery Bypass Grafting. Innovations (Phila). 2018 Jan/Feb; 13(1): 5-10.
• Gillinov AM, Mihaljevic T, Javadiksgari H, Suri RM, Mick SL, Navia JL, Desai MY, Bonatti J, Khosravi  M, Idrees JJ, Lowry AM, Blackstone EH, Svensson LG. Early Results of Robotically Assisted Mitral Valve Surgery: Analysis of the First 1000 Cases. J Thorac Cardiovasc Surg. 2018; 155-191.