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Robotic Beating Heart Tecab In Higher Risk Patients: Can It Be Done Safely?
Husam H. Balkhy, Sarah Nisivaco, Hiroto Kitahara, Mackenzie McCrory, Brooke Patel.
University of Chicago Medicine, Chicago, IL, USA.
OBJECTIVE: Patients with a high STS predicted risk of mortality (PROM) undergoing coronary bypass surgery (CABG) are known to have worse outcomes. Less invasive approaches have been shown to improve morbidity and mortality for these patients. In this study, we examine the impact of robotic assisted totally endoscopic beating heart CABG (TECAB) on perioperative outcomes in high-risk patients.
METHODS: The STS predicted risk of mortality score was reviewed for patients undergoing robotic TECAB at our institution between 7/2013 and 12/2016. We identified a higher risk cohort (STS score >4) and compared them to the lower risk group (STS score <4) during the same period. Perioperative data and outcomes from the two groups were collected retrospectively.
RESULTS: There were 30 patients in the high-risk group with a mean STS score of 8.43 + 3.96. Mean age was 70 and 60% were female. The low-risk group had 204 patients with a mean STS score of 1.07 + 0.9, a mean age of 64.6 and 22% were female. The high-risk group had predictably higher rates of prior myocardial infarction, congestive heart failure, renal insufficiency, PVD, and lower ejection fraction. The incidence of postoperative atrial fibrillation, stroke, myocardial infarction and wound infection were similar in the two groups. The incidence of prolonged ventilation (>24h) was similar as well, however extubation in the operating room was less in the high-risk group (7% vs 45% p=0.000). Perioperative blood transfusion and hospital length of stay were higher in the high-risk group (40% vs 15.7% p=0.001 and 3.88 + 1.6 vs 3.03 + 1.23 days p=0.002 respectively) . Mortality was slightly lower in the high-risk group (0% vs 1.96% p=0.045). Results are shown in Table 1.
CONCLUSIONS: We conclude that beating heart TECAB can be performed in patients with a higher STS predicted risk of mortality score with excellent outcomes. Further studies are warranted to evaluate the long-term results of TECAB in this challenging group of patients.
| Variable | High STS score (N=30) | Low STS score (N=204) | p value |
| STS score, mean | 8.43 + 3.96 | 1.07 + 0.9 | 0.000 |
| Age, years | 70 + 11.3 | 65 + 10.3 | 0.008 |
| Ejection Fraction, % | 38 + 15 | 52 + 13 | 0.000 |
| BIMA Use, n (%) | 13 (43) | 114 (56) | 0.199 |
| Blood Transfusion, n (%) | 12 (40) | 32 (15.7 | 0.001 |
| Prolonged Vent, n (%) | 4 (13) | 4 (2) | 0.061 |
| Hybrid Revasc, n (%) | 14 (47) | 72 (35) | 0.177 |
| Hosp LOS, days | 3.88 + 1.6 | 3.03 + 1.23 | 0.002 |
| Mortality, n (%) | 0 (0) | 4 (1.96) | 0.045 |
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