Hybrid Coronary Revascularization, Robotic-assisted Surgical Approach - Long Term Follow Up In 565 Patients.
Francis P. Sutter, Mary A. Wertan, Konstadinos Plestis, Daniel M. Cohen, Christina Spino-Oleck, Scott M. Goldman.
Lankenau Medical Center, Wynnewood, PA, USA.
BACKGROUND: Hybrid coronary revascularization (HCR) combines the survival benefit of left internal mammary artery (LIMA) bypass to left anterior descending (LAD) artery and percutaneous coronary intervention (PCI). While multiple studies prove that sternotomy coronary bypass generates better results than the PCI alone, few studies demonstrate the benefits of combining both of these procedures. The purpose of this retrospective study was to examine the long-term outcomes of 565 patients who were considered for hybrid revascularization over our experience in 12 years. METHODS: Hybrid coronary revascularization was performed in a staged approach, at a single institution, on 565 patients, from October 2005 through October 2016. Robotic-assisted internal mammary artery harvest, followed by direct vision beating heart anastomosis combined with PCI to other coronary lesions. Our collaborative heart team approach prioritizes the treatment for the culprit vessel. Surgery was performed first in 356 cases (63%), while PCI was primary procedure in 209 cases (37.0%). Retrospective data was obtained during patient follow-up; a set questionnaire addressed the occurrence of major adverse cardiac and cerebrovascular events (MACCE); including myocardial infarction, target vessel re-intervention, PCI to other vessels, recurrence of angina, stroke and overall death. Additionally we reviewed the most recent records on all patients from operative date through the date of last hospitalization or office visit. RESULTS: 565 patients were identified for hybrid revascularization, 71 patients (12.6%), underwent surgery but never underwent planned PCI, and these patients are included in data as intention to treat. The average follow-up was 4.9 patent years, (6 months to 12 years). Two patients were completely lost to follow-up and 29 patients had documented alive dates but lack follow-up MACCE data. Therefore we report MACCE on 529 patients, 94.5% of all hybrids performed at our institution. Over the study interval, 117 (22%) of patients reported some form of MACCE. 2.27% had myocardial infarction, 4.7% needed target revascularization, 9.36% had PCI to other coronary lesions and 3.2% had cerebrovascular accident and/or transient ischemic attack. Only two (2) patients required re-operative CABG. Overall mortality was 13.4 % over 12 year study period. Thus, 412 patients (78%) were free from MACCE, and patient satisfaction was high. CONCLUSION: Long-term follow-up indicates that hybrid robotic-assisted coronary revascularization is safe and effective. Patients undergoing this procedure benefit from improved long-term survival and low MACCE rates.
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