Benefit Of Robotic Connector Totally Endoscopic Coronary Artery Bypass In Octogenarians
Hiroto Kitahara, Mackenzie McCrorey, Brook Patel, Sarah Nisivaco, Husam H. Balkhy.
The University of Chicago, Chicago, IL, USA.
BACKGROUND One of the most important advantages of robotic beating heart connector totally endoscopic coronary artery bypass (C-TECAB) is early functional recovery, which would be beneficial for fragile patients, like octogenarians. However, the safety of C-TECAB in this challenging group of patients is still controversial. The aim of this study is to investigate the benefit of C-TECAB in octogenarians. METHODS We retrospectively reviewed patients undergoing C-TECAB from July 2013 to September 2017 in our center. We compared perioperative outcomes of patients 80 years or older versus younger. RESULTS During the study period, 308 patients underwent C-TECAB. Of these, 28 patients (9.1 %) were octogenarians. The majority of octogenarians were male (N = 22, 79 %), mean age of 83.8 ± 3.0 years. Octogenarians had higher rate of hypertension and atrial fibrillation compared to younger patients. C-TECAB was successfully performed with no conversion to sternotomy in octogenarians. The mean operative time (299 ± 83 minutes vs 281 ± 89 minutes, P = 0.309), rate of multi-vessel bypass (61% vs 58%, P = 0.798) and concomitant procedures (18 % vs 8 %, P = 0.084) were similar between octogenarians and younger patients. Postoperative complications including prolonged ventilation (> 24 hours), wound problems, acute kidney injury, myocardial infarction, and stroke were not observed in octogenarians. New atrial fibrillation was observed more frequently in octogenarians compared to younger patients (36 % vs 19 %, P =0.031). The mean length of hospital stay was similar between octogenarians and younger patients (3.9 ± 1.8 days vs 3.5 ± 3.0 days, P = 0.475). Twenty-two octogenarians (79%) were discharged directly to home. Perioperative mortality was 0 in octogenarians. Mortality at mid-term follow-up (mean 185 days) was 11 % (3/28) in octogenarians, and the reason of death was non-cardiac in all 3 patients. CONCLUSIONS In our experience, C-TECAB had favorable results in octogenarians with acceptable morbidity, mortality and excellent short length of stay similar to younger patients. Further studies will be necessary to evaluate longer-term outcomes of this approach in this group of patients.
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