International Society For Minimally Invasive Cardiothoracic Surgery

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Outcomes Post-conversion To Sternotomy In Robotically-assisted Coronary Artery Bypass Grafting: A Propensity Matched Study
Nickolas Christidis, Stephanie Fox, Stuart Swinamer, Rodrigo Bagur, Kumar Sridhar, Christopher Harle, Michael Chu, Patrick Teefy, Bob Kiaii.
London Health Sciences Center, London, ON, Canada.

Normal 0 false false false EN-CA X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; line-height:200%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-ansi-language:EN-CA;} Objective: Conversion to sternotomy is a recognized complication of robotically-assisted coronary artery bypass grafting (RA-CABG). However, the impact of conversion on patient outcomes has not been established. The purpose of this investigation is to evaluate the outcomes in patients converted from RA-CABG to sternotomy and compare them to conventional coronary artery bypass graft (CABG) surgery. Methods: Data from February 2004 to April 2017 was retrospectively reviewed for 73 patients converted from RA-CABG to sternotomy and 1955 patients who received conventional coronary artery bypass (CABG) with sternotomy. Propensity score matching was used to match 73 patients receiving conventional sternotomy CABG with the 73 patients converted from RA-CABG to sternotomy. Results: The two matched groups were balanced on all preoperative prognostic factors. Comparisons between patients converted from RA-CABG to sternotomy and matched conventional CABG yielded no significant differences in median length of intensive care unit stay (RA-CABG conversion, 1 day, range 0 - 20; conventional CABG, 1 day, range 1 - 43, p = .156) and median length of hospital stay (RA-CABG conversion = 5 days, range 3 - 43; conventional CABG = 6 days, range 2 - 50, p = .781). All postoperative complications were comparable between groups (see Table 1). Conclusions: Surgical revascularization in patients Converted to sternotomy during robotically-assisted minimally invasive coronary artery bypass grafting is just as safe as an elective conventional CABG, with comparable recovery times and adverse postoperative complication rates. As RA-CABG has been shown to decrease recovery time and improve patient satisfaction, this data supports that despite concerns with the potential for conversion to sternotomy during RA-CABG, patients would still achieve similar outcomes to a conventional CABG after conversion.
RA-CABG with conversion, n = 73Matched conventional CABG, n = 73P-value
ICU LOS, median (range), d1 (0 - 20)1 (1 - 43).156
Hospital LOS, median (range), d5 (3 - 43)6 (2 - 50).781
New AF12 (16.4%)9 (12.3%).479
Blood transfusion15 (20.6%)14 (19.2%).836
In-hospital mortality1 (1.4%)01.000
At least one of the 10 major adverse events10 (13.7%)6 (8.2%).289
Myocardial infarction2 (2.7%)0.497
Cardiac arrest02 (2.7%).497
Postoperative IABP02 (2.7%).497
Prolonged ventilation >24 hours3 (4.1%)2 (2.7%)1.000
Reoperation for bleed2 (2.7%)3 (4.1%)1.000
Mediastinitis3 (4.1%)0.245
Sternal dehiscence1 (1.4%)2 (2.7%)1.000
Septicemia00
Renal failure00
Neurologic complication00


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