Immediate And Long Term Outcomes With Angiographic Follow-Up Of Single Stage Hybrid Revasularization
Bob Kiaii, Michael Chu, Kumar Sridhar, Woijchek Dobkowski, CHRISTOPHER HARLE, PHILIP JONES, Stephanie Fox, Daniel Bainbridge, Patrick Teefy, Patrick Teefy.
London Health Sciences Center, London, ON, Canada.
Objective: Traditionally integrated coronary artery revascularization has been described as a two-stage procedure. We evaluated the safety and feasibility of single-stage simultaneous and two-stage hybrid robotic-assisted coronary artery bypass grafting surgery and percutaneous coronary intervention (PCI).
Methods: 108 patients underwent simultaneous integrated coronary artery revascularization in an operating theatre equipped with angiographic equipment. 78 were male and mean age was 61 years. 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. Immediately afterwards within the same operative suite, angiographic confirmation of graft patency and PCI with drug-eluting stents were performed. In 82 patients therapeutic anticoagulation was achieved using the direct thrombin inhibitor bivalirudin.
Results: There were no deaths or wound infections. There was one peri-operative myocardial infarction. One patient suffered a stroke and four 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. All patients were alive and symptom free at 84 months follow-up. Long term follow-up angiogram at mean 10 months of 71 patients showed 2 atretic and 4 non-patent grafts, otherwise the remainder of the grafts were all patent with 8 in-stent stenosis and 2 occluded stents. At mean 5 years follow-up the patency rate of LITA was unchanged at 95
Conclusion: For multi-vessel coronary artery disease, simultaneous hybrid robotic-assisted coronary artery revascularization using bivalirudin is safe and feasible. This approach allows complete multi-vessel revascularization with decreased surgical trauma and post-operative morbidity with very good long-term outcome. Randomized control trials are necessary to better determine long-term benefits of this technology.
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