Back to 2016 Annual Meeting Cardiac Track

OBJECTIVE: Totally endoscopic coronary artery bypass (TECAB) with robotic distal anastomosis, and robotic-assisted minimally-invasive coronary artery bypass (RA-MIDCAB) with robotic internal mammary artery harvest and direct hand-sewn distal anastomosis via an anterior thoracotomy, have both been reported as safe and efficacious. We compared hospital cost and short-term outcomes between these techniques.
METHODS: Patients who underwent robotic minimally-invasive single vessel CABG between 2011 and 2014 were retrospectively reviewed. One hundred consecutive patients underwent either TECAB (N=50) or RA-MIDCAB (N=50). The two groups were sequential and non-contemporaneous with TECAB performed by one surgeon in the first portion of the study interval and RA-MIDCAB by another surgeon in the latter. All TECAB procedures were performed by an experienced surgeon (>200 cases), while all RA-MIDCAB procedures were performed by a surgeon still within a learning curve (<75 cases). Demographic and operative data, short-term outcomes, and hospital cost data were compared between the two groups.
RESULTS: Patient demographics and preoperative risk factors were similar between the TECAB and RA-MIDCAB groups, as were median operative (3.5 (IQR 2.9-3.9) vs. 3.3 (IQR 3.0-4.2) hours, p=NS) and total operating room times (5.2 (IQR 4.5-5.7) vs. 5.2 (IQR 4.6-5.8) hours, p=NS). Cardiopulmonary bypass was used for 56% of TECAB and 0% of RA-MIDCAB cases (p<0.01). Hybrid revascularization was performed in 40% of TECAB and 28% of RA-MIDCAB patients (p=NS), and was nearly universally staged postoperatively during the same hospitalization. The duration of ventilation, and lengths of ICU and hospital stay were similar between groups. Readmission rates were 12% and 14% for TECAB and MIDCAB (p=NS), respectively; and 30-day or in-hospital mortality was 2% in the TECAB and 0% in the RA-MDCAB group (p=NS). Total hospital cost was significantly higher with TECAB compared to RA-MIDCAB (33,769 (IQR 28,237-41,505) vs. 22,679 (IQR 19,293-30,106) dollars, p<0.01), which was primarily driven by operative costs (17,616 (IQR 14,888-20,451) vs. 26,803 (IQR 19,458-30,756) dollars, p<0.01).
CONCLUSIONS: TECAB and RA-MIDCAB both demonstrated excellent short-term clinical outcomes. However, TECAB was associated with significantly higher hospital costs. Further comparisons, including long-term outcomes, patient satisfaction and functional status, are needed to evaluate if this additional cost is justified.