Arrested heart TECAB versus MIDCAB for revascularization of the anterior wall. A comparative analysis of perioperative and midterm results
Nikolaos Bonaros1, Markus Kofler1, Benedikt Hofauer1, Guy Friedrich1, Johannes Bonatti2, Thomas Schachner1.
1Innsbruck Medical University, Innsbruck, Austria, 2Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
OBJECTIVE: The ideal method to place an internal mammary artery (IMA) graft to the anterior wall of the left ventricle remains unclear. Robotics allow totally endoscopic IMA harvesting and either robotically assisted placement of the anastomosis in a totally endoscopic fashion (TECAB) or hand-sewn via mini-thoracotomy (MIDCAB). The aim of the study was to compare both techniques in terms of perioperative and midterm results.
METHODS: Robotically assisted arrested heart TECAB was carried out in 195 patients with a median age of 59 (31-77) years and median EuroScoreI of 1.5 (0-7). Robotic MIDCAB was performed in 43 patients with a median age of 64(45-82) years and median EuroScoreI of 2 (0-11). Both techniques were used for single or sequential IMA grafts to the anterior wall. Perioperative results were compared between the groups by Mann-Whitney test for continuous variables and chi square or Fisher’s exact test for categorical variables. Kaplan-Meier plots and log-rank test were used to compare midterm results.
RESULTS: No perioperative deaths were noted. Surgical difficulties resulting in longer operative times or change in the operative strategy occurred in 60 (30%) of the TECAB and 6 (14%) of the MIDCAB group (p=0.06). Angiographically verified anastomotic stenosis was detected in 6(3%) and 3 (7%) respectively (p=0.190). Conversions to larger thoracic incisions were needed in 17 (9%) and 3 (7%) respectively (p=0.887). Total operative times were longer in the TECAB vs the MIDCAB group (291 (175-690) min vs. 201 (98-510) min), (p=0.000001). ICU and total length of stay were similar between the groups. Maximum CK levels of 573 (59-11462) mg/dl vs 301 (193-782) mg/dl (p=0.957) and maximum CK-MB levels of 21 (7-162) mg/dl vs. 17 (9-26) mg/dl (p=0.091) did not differ for the two groups. There was no difference in survival (0 vs 2% p=ns), freedom from angina (5 vs. 2%, p=0.380) and freedom from MACCE (10 vs 5%, p=0.270) at a median follow up of 24(0-100) months.
CONCLUSIONS: Robotically assisted arrested heart TECAB and robotic MIDCAB perform equally in terms of perioperative results and mid-term follow up in this single center patient cohort.
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