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Long-term Effectiveness of Robotic Assisted Hybrid Revascularization
Jorge Catrip, Jeevan Nagendran, Stephanie Fox, Michael Chu, Patrick Teefy, Kumar Sridhar, Shahar Lavi, George Jablonsky, Stuart Swinamer, Jill Gelinas, Pantalis Diamantouros, Bob Kiaii.
University of Western Ontario, London, ON, Canada.

Introduction: Hybrid coronary artery revascularization using left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) integrated with percutaneous coronary angioplasty offers a multi-vessel revascularization in high-risk patients with minimal morbidity. The advantage of this procedure is achieved by avoiding the use of cardiopulmonary bypass along with the use of robotic assisted minimally invasive technique. The objective of this study was to assess long-term clinical follow-up, with graft and stent patency at 5 to 10 years following robotic assisted hybrid coronary revascularization.
Methods: 154 patients underwent robotic assisted hybrid coronary revascularization. The LITA was harvested with robotic-assistance and anastomoses were manually constructed via a small anterior non-rib spreading incision or closed chest robotic assistance without the use of cardiopulmonary bypass on the beating heart. Patients underwent PCI either during the same stage or after surgery as a second stage during the same hospitalization. Patients underwent yearly clinical follow-up. Graft patency was assessed at 6 months with cardiac catheterization and at 5 to 10 years with single-photon emission computed tomography myocardial perfusion scintigraphy.
Results: There were a total of 154 (61 ± 12 years; 26% female) patients undergoing revascularization. There were no deaths or wound infections. There was one peri-operative myocardial infarction and one peri-operative stroke. There were four reoperations for bleeding. At 5 to 10 year follow-up the patency rate of the LITA-to-LAD anastomosis was 94%. The patency rate of coronary stents was 92%.
Conclusion: The robotic assisted hybrid revascularization strategy with LITA-to-LAD anastomosis and PCI to ≥ 1 other coronary artery is safe and feasible. This approach provides excellent outcomes at 5 to10 years and allows for complete revascularization of patients with multi-vessel coronary artery disease without a median sternotomy and cardiopulmonary bypass. Randomized controlled trials are necessary to discern the long-term benefits of hybrid complete revascularization when compared to conventional coronary artery revascularization.

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