Assessment Of Residual Syntax Score After Advanced Hybrid Robotic Totally Endoscopic Multi-vessel Coronary Revascularization
Hiroto Kitahara, Taishi Hirai, Mackenzie McCrorey, Brook Patel, Sarah Nisivaco, Sandeep Nathan, Husam H. Balkhy.
The University of Chicago Medical Center, Chicago, IL, USA.
BACKGROUND The aim of this study was to quantify residual coronary artery disease by using baseline SYNTAX score (bSS), and residual SYNTAX score (rSS) after advanced hybrid coronary revascularization (AHCR; robotic multi-vessel beating heart connector totally endoscopic coronary artery bypass (C-TECAB) with PCI). METHODS We performed a retrospective chart review of the patients who underwent AHCR from July 2013 to September 2017 at our institution. bSS and rSS were measured on pre- and postoperative coronary angiography. Cohorts were stratified according to complete revascularization (CR; rSS = 0) and incomplete revascularization (IR; rSS > 0). RESULTS 180 patients underwent multi-vessel C-TECAB, of whom 57 patients (31.7 %) received AHCR with bilateral or sequential internal mammary artery (BIMA) grafts (mean age 65.6 ± 8.8 years, 45 male). Mean operative time was 318.4 ± 51.0 minutes. BIMA use was 50 patients (87.7 %). Mean postoperative length of ICU and hospital stay was 1.4 ± 0.8 days and 3.0 ± 1.3 days, respectively. PCI was performed before (7.7 %), simultaneously (3.8 %) or after (88.4 %) C-TECAB in the right coronary artery only in 70.2 % (40/57), the left circumflex artery only in 10.5 % (6/57), multiple lesions in 10.5 % (6/57), and not attempted or failed in 8.8 % (5/57). Mean bSS was 27.2 ± 11.5 (range 9 to 63) and mean rSS was 2.6 ± 3.5, were calculated in 48 patients. Mean post procedural change in SS by C-TECAB was 18.7 ± 9.5, and by PCI was 6.1 ± 4.6. CR was achieved in 24 patients (50 %). There were no differences in preoperative characteristics or postoperative outcomes between the CR group and the IR group. 30-day mortality was 0 in both groups. 1-year survival trended higher in the CR group compared to the IR group, however, there was no statistical significance (100 % vs 89.5 %, P = 0.086) CONCLUSIONS This is the first study of residual syntax score after hybrid coronary revascularization. CR (as calculated by rSS) was achieved in half the patients. Further studies will be necessary to study the impact of rSS on the efficacy of hybrid revascularization.
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