Robotic-assisted Coronary Bypass Grafting Surgery: An 18-year Single Centre Experience With Long-term Follow-up
Vincenzo Giambruno, Feras Khaliel, Philip Jones, Michael Chu, Patrick Teefy, Kumar Sridhar, Daniel Bainbridge, Christopher Harle, Bob Kiaii.
London Health Sciences Centre, London Ontario, ON, Canada.
Robotic-assisted Coronary Bypass Grafting Surgery: An 18-Year Single Centre Experience with Long-term Follow-up.
OBJECTIVES: Robotic-assisted minimally invasive coronary artery bypass Grafting (RA-CABG) surgery has emerged as a feasible minimally invasive surgical revascularization technique that might offer several potential advantages over conventional approaches. We present our 18-year experience in RA-CABG with long-term follow-up.
METHODS: Between February 1998 and October 2016, 605 patients underwent RADCAB. Off-pump left internal thoracic artery (LITA) to the left anterior descending coronary artery (LAD) grafting was performed either through a mini-thoracotomy or totally endoscopic approach after robotic LITA harvest. 151 of these patients underwent hybrid coronary revascularization combining a percutaneous coronary intervention to the non-LAD vessels. Patients underwent post-procedural selective graft patency assessment using cardiac catheterization. The average clinical follow-up was 81.2±44.4 months.
RESULTS: The rate of conversion to sternotomy for any cause was reduced from 16.0% of the first 200 cases, Reduced to 6.9% of the last 405 patients. The patency rate of the LITA-to-LAD anastomosis was 97.4%. Surgical re-exploration for bleeding occurred in 1.8% of patients, and the transfusion rate was 9.2%. The peri-operative myocardial infarction rate was 1.3%. A cerebral vascular accident occurred in 1% of the cases. Only 1 patient (0.2%) developed renal failure requiring dialysis, and 5 patients (0.8%) required a prolonged mechanical ventilation. Average ICU stay was 1.2±1.4 days, and average hospital stay was 4.8±2.9 days. In-hospital mortality rate was 0.3%. 81.2±44.4 months clinical follow up demonstrated 86.5% survival, 92.3% freedom from angina, 92.1% freedom from any form of coronary reintervention.
CONCLUSIONS: Robotic-assisted coronary artery bypass grafting is safe, feasible and it seems to represent an effective alternative to traditional coronary artery bypass grafting in selected patients. Although this technique requires a dedicated team with specialized equipment and advance training, it offers the potential for less traumatic myocardial revascularization with reduced postoperative morbidity and excellent long-term results.
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