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Robotic-Assisted Direct Coronary Artery Bypass (RADCAB): Does The Addition Of Hybrid Increase Morbidity And Length Of Stay In The Hospital?
Feras Khaliel, Vincenzo Giambruno, Michael WA Chu, Kumar Sridhar, Patrick Teefy, Bob Kiaii.
London Health Science Center, Western University of Ontario, London, ON, Canada.

Robotic-Assisted Direct Coronary Artery Bypass (RADCAB): Does The Addition Of Hybrid Increase Morbidity And Length Of Stay In The Hospital?
Objective:
Patients post coronary revascularization surgery often receives blood product transfusion, which could delay their ICU and hospital discharge. We elaborate the blood transfusion rate in all our RADCAB and compare their long-term outcome.
Methods:
Between November 2003 and November 2015, 483 consecutive patients underwent RADCAB surgery. They were divided into two groups. 147 consecutive patients (Group-1) mean age 61.4±11.1 years; 22.5% females) underwent robotic-assisted hybrid coronary artery revascularization with LITA to the LAD and PCI to a non-LAD vessel. Group-2 (336 patients) non-hybrid RADCAB, mean age 61± 10.4 years old (37-87) 25% were females. Peri-operative and late post-operative follow-up has been obtained with average 83.6±11.1 months.
Results: See table below;
% (n)Group-1Group-2
Hospital Mortality00.4 (2)
Conversion to Sternotomy4.7 (7)16 (55)
HBG level Pre-Op140±16110±16
HBG level Post-Op144 ±13.4114±15.9
Blood Transfusion14.2 (20)6.8 (23)
ICU Stay1±1 days1.2±1.6 days
Hospital LOS4±2 days5±3.7 days
Re-exploration for bleeding3.4(5)1.2 (4)
Re-intervention for Graft Review0.7(1)3.6(12)
Wound infection00.6(2)

Blood transfusion rate in Group-2 was 6.8% (23patients), which included transfusion of FFP, Platelet and PRBCs in 15, 8 and 22 patients, respectively.
Based on the intra-op Cardiac Catheterization, 12 grafts required revision. 4 patients required exploration for bleeding. Post-operative GI bleeding found in two patients. No patient developed renal failure.
Post-operative coronary angiogram control and follow-up was done in 100% of patients showing a 98% graft patency.
Conclusion:
Despite the matched propensity of patient demography in both groups, we have observed a significant increment in the blood transfusion rate in Group-1 that also lead into a significant increment in re-exploration for bleeding rate. Dual
anticoagulation therapy in the hybrid group might be the cause. Nevertheless, it didn’t affect the length of ICU or hospital stay.
Moreover, The trend of having a better survival in the multiple coronary artery re-vascularization through hybrid technique is encouraging to enroll more patients into this technique.


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