15 Year Experience With Robotic-Assisted Coronary Artery Bypass Grafting With Post-Operative Angiography
Bob Kiaii1, Michael Chu1, Reiza Rayman1, Stuart Swinamer1, Stephanie Fox1, Woijchek Dobkowsi1, George Jablonsky1, Kumar Sridhar1, Patrick Teefy1, Alan Menkis2, Douglas Boyd3.
1London Health Sciences Center, London, ON, Canada, 2St. Boniface Hospital, Winnipeg, MB, Canada, 3University of California Davis, Sacramento, CA, USA.
Minimally Invasive coronary artery bypass grafting (CABG) is a rapidly evolving technology that has been shown to increase patient satisfaction and to reduce surgical morbidity and recovery times. Therefore, we present our institutional experience with minimally invasive robotic-assisted CABG with post operative cardiac catheterization.
The study cohort includes all patients who underwent robotic-assisted CABG between September 1998 and December 2013. All internal thoracic arteries were harvested with robotic-assistance, and anastomoses were manually constructed through a small anterior non-rib spreading incision or closed chest robotic assistance without cardiopulmonary bypass on the beating heart. Angiographic confirmation of graft patency was performed either immediately within the same operative suite equipped with angiographic equipment, or next day in the cardiac catheterization lab.
Since 1998 a total of 509 patients underwent robotic-assisted minimally invasive CABG. Total of 373 patients were males and mean age was 60 years. There were 2 deaths (0.4%) secondary to respiratory complications and 6 wound infections (1.2%). Seven (1.4%) patients required re-exploration for bleeding. Median length of stay in the intensive care unit was 1 day and length of hospital stay was 4 days. The patency rate of left internal thoracic artery (LITA) grafts to the left anterior descending artery (LAD) was 98.6% with 7 occluded grafts, which underwent revision.
Robotic-assisted CABG is a safe and feasible alternative approach to surgical revascularization. It has the potential of reducing morbidity of surgery by reducing infection and bleeding. Post operative assessment with cardiac catheterization enables the achievement of a very high postoperative patency rate.
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