International Society For Minimally Invasive Cardiothoracic Surgery

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Ten-year Clinical Outcomes And Graft Patency After Robotic Off-pump Coronary Artery Bypass Grafting
Rong Wang, Huajun Zhang, Changqing Gao.
PLA General Hospital, Beijing, China.

Background: Although different techniques of robotically assisted coronary bypass grafting have been adopted with excellent early and mid-term results at experienced centers, the long-term outcomes and graft patency are unknown. This study aims to investigate the 10-year clinical outcomes and graft patency after robotic off-pump totally endoscopic coronary artery bypass grafting (TECAB) and robotically assisted mini-thoracotomy coronary artery bypass grafting (MINICAB). Methods: From January 2007 to December 2017, 278 patients underwent robotic off-pump CABG by using da Vinci Surgical System (Intuitive Surgical, USA) in our institution. The average age at surgery was 58.5 years (range, 33 to 80 years) and there 78.1% of the patients are male. TECAB was undertaken in 126 cases and MINICAB in 152 cases. The internal mammary artery (IMA) was used to graft left anterior descending artery in all patients. Thirty-nine patients were planned for hybrid coronary revascularization in separate stages. The patients were followed out to ten years on mortality, incidence of stroke, requirement for repeated intervention due to refractory angina or myocardial infarction and major adverse cardiac and cerebral events (MACCE). IMA graft patency was evaluated by coronary angiography or CT angiogram (CTA) during the study period. Results: In the median follow-up of 81 months (range, 7 to 132) months, 93.1% of the patients were followed successfully. A total of 17 deaths (6.6%) were noted including 5 from cardiac origin (1.9%) and 4 from stroke (1.5%). TECAB and MINICAB subgroups showed similar five-year rates of survival (94.6% vs. 95%, p=0.20), freedom from stroke (95.8% vs. 96.1%, p=0.57), and freedom from repeated re-intervention (85.2% vs. 92.9%, p=0.18). However, TECAB patients showed higher incidence of MACCE than MINICAB 5 years after operation (22.8% vs. 14.6%, P=0.048). Although IMA graft patency was similar between two subgroups at 5 years post-operatively (TECAB 97.8% vs. MINICAB 98.3%, p=0.17), there was a tendency of higher degree of graft failure in TECAB beyond 5 years. Conclusions: Robotic off-pump CABG, either TECAB or MINICAB, is safe and effective for selected patients. The long-term clinical outcomes and graft patency are excellent.

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