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CLINICAL OUTCOMES OF TOTAL ENDOSCOPIC CORONARY ARTERY BYPASS (TECAB), A SINGLE CENTER EXPERIENCE
Francis P. Sutter1, MaryAnn A. Wertan1, Khawar Maqsood1, Wajeeha Saeed2, Trisha Senss1, Janet L. Reynolds1, Anny Luong1, Rizwan Sardar1.
1Lankenau Medical Center, Wynnewood, PA, USA, 2Montefiore Medical Center, New York, NY, USA.

BACKGROUND: Totally endoscopic coronary artery bypass (TECAB) is the least invasive form of coronary artery bypass grafting surgery. TECAB - its outcomes; exploring its potential use and selecting the appropriate patient population still need to be evaluated. This new minimally invasive technique has never been compared with robotic assisted internal mammary takedown with direct visualization coronary artery bypass grafting.
METHODS: We retrospectively reviewed consecutive single vessel robotic coronary revascularization cases from the start of our TECAB experience 01/01/2011 through 09/30/2012; comparing all TECAB procedures with precision incision single vessel small thoracotomy (SVST) procedures. Simple parametric testing Chi-square and 2 tailed t-test are employed.
RESULTS: TECAB group n=54, have lower mean Society of Thoracic Surgery predicted risk of mortality score 0.01, p=<0.001, less intra & post op blood transfusion, p=<0.001 & 0.002 respectively, shorter ICU stay 47:42±19:35 hours p=0.003 and more frequent extubation in the OR 92.6%, p=0.02. Fewer required readmission within 30days of surgery 3.7%, p=0.015. There were comparable total OR duration, post op atrial fibrillation, renal failure and operative mortality. TECAB was more frequently performed as an elective procedure. Precision incision SVST group n=117, have more patients with history of CHF p=<0.001 but LVEF< 40% was not significant and other baseline characteristics were similar between two cohorts.
CONCLUSION: Careful case selection and specialized plan of care permits improved outcomes and will further promote the acceptance of robotic assisted technology in coronary revascularization. TECAB is found to be safe and when performed in the correct patient population will broaden the advantages of robotic technology.


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