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Long Term Follow-Up of Robotic Assisted Hybrid Coronary Artery Revascularization with CT Angiography
Daniel Burns, MD, Jonathan Romsa, MD, Stephanie Fox, Michael Chu, MD, Bob Kiaii, MD.
University of Western Ontario, London, ON, Canada.
BACKGROUND: We evaluated the patency of surgically revascularized as well as stented coronary arteries at approximately 5 years after undergoing one-stage hybrid revascularization with robotic assistance and percutaneous coronary intervention.
METHODS: At the time of the study’s inception, 21 patients had undergone one-stage hybrid coronary revascularization at an approximate 5-year interval. This consisted of robotic assisted left internal thoracic artery (LITA) harvest, anastomosis to left anterior descending (LAD) artery off-pump via minimally invasive anterior thoracotomy, and immediate subsequent percutaneous coronary intervention of the remaining vessels as a one-stage procedure. LITA-LAD graft patency was confirmed via angiography at the time of operation, and then again at 6 months along with stent patency. Those patent at 6 months were then eligible for further long-term follow-up. The mean duration of follow-up was 65.3 months (+/- 4.8). Of the 21 eligible patients, 12 were found to be eligible for long-term follow-up, with 9 excluded. 3 patients had obtuse marginal artery stenting, 3 had right coronary artery stenting, 4 had diagonal artery stenting, 1 had circumflex artery stenting, and 1 had distal LAD stenting. The patients were contacted and informed consent was obtained. Patients attended a one-day appointment for CT angiography of the coronary vessels and sestamibi cardiac perfusion scan.
RESULTS: Of the 9 patients excluded, there were: 3 deaths remote from surgery, 1 stroke remote from surgery, 2 elective exclusions, 1 case of chronic renal disease unable to receive intravenous contrast, 1 early post-operative graft occlusion, and 1 unreachable patient. Of the 12 eligible patients, there were 11 (91.7%) patent LITA-LAD grafts. There was only 1 case of stent occlusion, involving the circumflex artery.
CONCLUSIONS: One-stage hybrid coronary revascularization with robotic assistance and percutaneous coronary intervention shows favorable long-term results in treating patients with multi-vessel coronary artery disease. However, greater numbers are required to fully delineate long-term results and clinical outcomes.
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