Robotic Totally Endoscopic Coronary Bypass With Connectors: Mid Term Outcomes After Transitioning To A New Hospital
Husam H. Balkhy, Sarah Nisivaco, Dorothy Krienbring, Mackenzie McCrory, Hiroto Kitahara, Brooke Patel, Susan Arnsdorf.
University of Chicago Medicine, Chicago, IL, USA.
OBJECTIVE: Between 1/2007 and 12/2016 we performed 500 robotic totally endoscopic connector coronary bypass procedures. Of these 234 were performed after moving to a new institution in July 2013. The same team (console surgeon and patient-side assistant) made the transition to reproduce the same operative approach. This report examines intra and post-operative outcomes of this latter group of patients as well as mid-term clinical outcomes.
METHODS: We performed a retrospective review of our robotic connector TECAB experience (234 patients) at a new institution from 7/2013 to 12/2016. The C-Port Flex A distal anastomotic device was used for the majority of the grafts. Clinical follow-up of 226 (97%) patients was conducted by telephone interview at a mean of 19 months. Angiographic patency data was available for 30% of patients (mostly those undergoing hybrid revascularization) at a mean of 95 days.
RESULTS: Mean age was 65.3 and 73% of patients were male. Mean STS score was 2.02 (0.17-17.9). There were 90 (38%) single vessel, 123 (53%) double vessel, and 21 (9%) triple vessel TECAB procedures. Bilateral IMAs were used in 127 (54%) patients; and 7 (3%) patients had previous cardiac surgery. Conversion to sternotomy occurred in 1 patient (0.44%). Mean hospital length of stay was 3.32 ± 1.69 days. Mortality was 1.7%. Hybrid revascularization was performed in 69 (29.5%) patients of which 46 were complex hybrids (i.e. multi vessel TECAB). At 19 month follow-up cardiac mortality was 4.3%; and 8 (3.4%) of patients had an MI or repeat coronary intervention. Graft patency was evaluated for 66 patients (117 grafts) at a mean of 95 days. LIMA (73) and RIMA (44) graft patency was 98.6% and 95.5% respectively.
CONCLUSIONS: We conclude that robotic beating heart TECAB with the Flex A anastomotic connector is safe and reproducible. It can be transitioned by an experienced robotic team to a new institution with excellent short and mid term outcomes as long as careful attention to detail is undertaken during the transition.
|Mean Robotic time, min (TECAB x1, x2, x3)||176, 289, 357 min|
|LIMA Flow/Pulsatility Index||Flow: 75||PI: 1.6|
|RIMA Flow/Pulsatility Index||Flow 69||PI 1.4|
|Extubation % (on table/within 6 hours)||On table: 40%||Within 6h: 78%|
|Mean Chest tube drainage, mL (first 24h/total)||First 24h: 579||Total: 766|
|Blood transfusion (intraop/total), n (%)||Intra-op: 33 (14%)||Total: 52 (22%)|
|Myocardial Infarction, n (%)||1 (0.4%)|
|Stroke, n (%)||1 (0.4%)|
|Mortality at 19 months, (N=226)||10 (4.3%)|
|Graft Patency mean 95 days, (N=117)||114 (97.4%)|
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