Robotic Tecab To Complete Three Or More Grafts: Pushing The Envelope Of Endoscopic Beating Heart Cabg
Sarah Nisivaco, Gianluca Torregrossa, Kaitlin Grady, Husam H. Balkhy
University of Chicago, chicago, IL, USA
Background: Totally endoscopic coronary bypass surgery is the least invasive form of coronary revascularization but is perceived to be limited by the number of distal anastomosis that can be performed. Robotic TECAB with the aid of the Endo-wrist stabilizer allows the harvesting of bilateral internal thoracic arteries (BITA) and their deployment in multiple coronary territories using sequential anastomoses. This report aims to evaluate outcomes in our patients undergoing Robotic TECAB with 3 or more grafts Methods: A retrospective analysis of 485 patients who underwent TECAB at a single institution from 2012 to 2019 was performed. Thirty-six patients had a BITA TECAB X 3 or X 4. Pre-operative, intraoperative and post-operative results at 30 days and at a mean follow up of 31±20.1 months, were analyzed. Results: Mean age was 67±6.8 years. Mean STS risk score was 1.3±1.87. 78% of patients had 3-vessel disease and 44% of patients had BMI ≥ 30. Thirty-eight percent of patients were diabetic and 5 patients had a diagnosis of chronic renal failure. Mean ejection fraction was 53%±12.0 and 33% of patients had previous percutaneous intervention (PCI). There were no conversions to sternotomy and 39% underwent staged hybrid revascularization. Intraoperative blood transfusion was required in 3 patients, and all procedures were successfully completed using an off pump strategy. The mean LIMA flow was 56 ± 16.5 ml/min; mean RIMA flow was 55±22.5 ml/min using intraoperative trans-time flow measurement. Mean hospital length of stay (LOS) was 2.56±1 days. There were no re-explorations for bleeding or wound infections. At 30 days, there was one death due to carotid artery stent thrombosis. At 31±20.1 months follow-up, 1 patient had a cardiac related mortality (pulmonary embolism). Eleven (30%) patients had a post-operative angiogram and the overall graft patency was 94%; freedom from MI, cardiac reoperation and culprit vessel PCI was 87%. Conclusions: In the hands of a dedicated coronary team, off pump TECAB BITA multivessel bypass with 3 or more grafts is feasible and allows to spread the benefit of multiarterial grafting to a selected subset of patients using a totally endoscopic approach, improving post-operative recovery and LOS.
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