International Society For Minimally Invasive Cardiothoracic Surgery

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Robotic-assisted Surgical Revascularization In Patients With Multi-vessel Disease And Total Occlusion Of The Right Coronary Artery
Chi Chi Do-Nguyen1, George O. Ajene1, Francis P. Sutter2, Mary Ann C. Wertan2.
1Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA, 2Lankenau Medical Center, Philadelphia, PA, USA.

BACKGROUND - The impact of chronic total occlusion (CTO) of the right coronary artery (RCA) and its association with outcomes of revascularization in patients with multi-vessel disease undergoing robotic coronary revascularization (rCR) remains unknown. Our study aims to compare rCR outcomes between patients with 2- vs. 3-vessel disease with CTO of the RCA.
METHODS - Robotic-assisted internal mammary artery (IMA) harvest, followed by direct vision beating heart anastomosis to the left anterior descending artery (LAD) target site, was performed in a single tertiary institution from July 2014 to June 2018. Patients with CTO of the RCA were included in this study. Data were obtained from chart review.
RESULTS - In our institution, 19% of total CABGs are robotic-assisted and 116 patients with CTO of the RCA were considered for robotic-assisted IMA to LAD. Two patients were excluded due to operative mortality. Hybrid coronary revascularization of IMA bypass to the LAD and percutaneous coronary intervention (PCI) was performed in 47.4% of patients. Left IMA was used for 113 patients and right for 1. 73.7% of patients had 3-vessel coronary disease, 25.4% had 2-vessel, and 0.9% had 1-vessel. The mean survival for all patients was 19.2 months, with a 94.7% survival rate. No patients had a follow-up myocardial infarct nor repeat CABG. In the 3-vessel cohort, the mean survival was 19.0 months (n=84), with a 94.0% survival rate. 22.6% had a return of heart symptoms, including angina, angina equivalent, SOB, and CHF. 2.4% had a follow-up stroke, 7.1% had repeat catheterization, 3.6% had repeat PCI with 66.6% in a new vessel, and 0% had subsequent RCA intervention. In the 2-vessel cohort, the mean survival was 18.9 months (n=29), with a 96.6% survival rate. 17.2% had a return of heart symptoms, 0% had a follow-up stroke, 10.4% had repeat catheterization, 6.9% had repeat PCI in a new vessel, and 3.4% had subsequent RCA intervention.
CONCLUSIONS - Robotic-assisted CABG of IMA to LAD in patients with multi-vessel coronary artery disease and CTO of RCA was found to be associated with lower incidence of post-operative MACCE and less follow up coronary revascularization interventions.

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