Does Changing The Anastomotic Approach Affect Outcomes In Robotic Off-pump Totally Endoscopic Coronary Artery Bypass?
Makoto Hashimoto, Sarah Nisivaco, Husam H. Balkhy
University of Chicago, Chicago, IL, USA
Background: Recently, the distal coronary anastomotic connector, which is used in robotic totally-endoscopic coronary artery bypass (TECAB), has become less available due to marketing considerations. The aim of this study was to analyze the effect of changing the dominant anastomotic technique from automated to hand-sewn in our TECAB procedures. Methods: Between June 2017 and June 2019, 182 patients underwent TECAB in our institution. Of these, 90 patients underwent TECAB with an abundant supply of the distal anastomotic device during the first half (Group-1), and 92 patients underwent TECAB when the device was significantly less available in the latter half (Group-2). All coronary anastomoses were performed using the distal anastomotic device or a hand-sewn continuous suture with 7-0 Pronova. We retrospectively analyzed clinical outcomes of these two groups. Results: There was no difference in demographics. Off-pump TECAB was completed in 98% (179/182 patients) with mortality of 0.6% (1/182patients). In Group-1, the anastomotic device was used in 87% of 145 grafts, while it was used in only 32% of 142 grafts in Group-2 (p<0.001). There were no differences in multivessel surgery (52% vs. 51%; p=0.879), bilateral internal mammary artery use (46% vs. 35%; p=0.307), and robotic operative time (234min vs. 249min; p=0.236) between the groups. However, when focusing only on 2-vessel TECAB cases, the operative time was shorter in Group-1 (274min vs. 302min; p=0.017) (Table). Group-1 patients had a tendency of higher intraoperative graft revision rate (3.4% vs. 0.7%; p=0.092) and lower cardio-pulmonary bypass support (1.1% vs. 2.2%; p=0.158). The early outcomes were similar between the groups. Follow-up data revealed excellent early graft patency (98% vs. 94%; p=0.387) and Freedom from MACE (96% vs. 100%; p=0.190) in both groups. Conclusions: Decreased anastomotic device usage was not associated with increased operative risk or time during robotic TECAB in experienced hands. The device conferred shorter operative times in multivessel TECAB, and can be important in patients intolerant of prolonged ischemic times. We still believe its use can facilitate broader adoption of TECAB. 
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