Avoiding Sternotomy To Enhance The Use Of Bita Grafts In Diabetic Patients. The Value Of Robotic Tecab In Multiarterial Cabg
Gianluca Torregrossa, Sarah Nisivaco, Charocka Coleman, Husam H. Balkhy
University of Chicago, chicago, IL, USA
Background: Diabetics, who present with coronary artery disease at a younger age, benefit the most from multiarterial grafting. However, the use of bilateral internal thoracic arteries (BITA) in coronary artery bypass grafting (CABG) via sternotomy is less than 5% in the US general population due to concerns of sternal wound infection. Robotic TECAB avoids sternotomy, maintains the proximity of the RITA to the heart (enhancing its reach), and improves post-operative recovery and length of stay (LOS). This study evaluates outcomes in our Diabetic patients undergoing robotic TECAB with 2 internal thoracic artery grafts. Methods: A retrospective analysis of 87 diabetic patients undergoing BITA TECAB (constituting 18% of 485 TECAB patients) between 7/2013-12/2019 in a single institution was performed. Pre-operative, intraoperative and post-operative results at 30 days and at mean follow-up of 28.9 ± 17.7 months, were analyzed. Results: Mean age was 68 years. Mean STS risk score was 2.18. Fifty percent of patients had BMI ≥30. Mean ejection-fraction was 51.3% and 40% of patients had previous percutaneous intervention. There were no conversions to sternotomy and 44% underwent staged hybrid revascularization. Intraoperative blood transfusion was required in 8% of patients, while femoral cardiopulmonary bypass was necessary in 2 patients to support gas exchange. The mean LITA flow was 75.7 ± 40 ml/min, while mean RITA flow was 68.6 ± 31.4 ml/min using intraoperative trans-time flow measurement. Extubation in the OR occurred in 35% of patients and mean hospital LOS was 3 days. There were no re-explorations for bleeding. At 30 days there was one death due to carotid stent thrombosis. At follow-up, there were no wound infections, four patients had a cardiac related mortality and 41% of patients had post-operative angiograms. The overall graft patency was 95%; freedom from MI, cardiac reoperation and culprit vessel PCI was 92%. Conclusions: The adoption of TECAB enhances the use of BITA revascularization in diabetic patients. In the hands of a dedicated robotic coronary team, TECAB BITA is feasible and allows to spread the benefit of multiarterial grafting to the patients at increased risk of wound infection.
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