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International Society For Minimally Invasive Cardiothoracic Surgery

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Clinical Outcomes Of Robotic Assisted Hybrid Coronary Artery Revascularization With Graft Patency At 10 Years
Kim Chai Chua1, Yehia Moharrem2, Alireza Jajali2, Stephanie Fox2, Christopher Harle2, Philip Jones2, Ivan Iglesias2, Shahar Lavi2, Patrick Teefy2, Bob Kiaii2.
1National Heart Centre Singapore, Singapore, Singapore, 2London Health Science Centre, London, ON, Canada.

BACKGROUND:
Hybrid coronary revascularization (HCR) combines minimally invasive surgical revascularization of the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) of non-LAD vessels. The utilization of robotic assisted-HCR is increasing due to its advantage of avoiding sternotomy and cardiopulmonary bypass, however the long-term patency and clinical outcome remain unknown. To assess the patency of graft and stent, and clinical outcomes of robotic-assisted HCR patients, a 10-year follow-up study was conducted in a single center.
METHODS: 89 patients who underwent robotic-assisted HCR from September 2004 to September 2009 were enrolled in this study. All patients underwent robotic assisted left internal thoracic artery (LITA)-LAD bypass graft and at least one PCI to a non-LAD vessel. Patients underwent computed tomography angiography (CTA) and myocardial perfusion scintigraphy (MPS-MIBI) at rest and with stress at follow-up. Patients also completed quality of life questionnaires (Seattle angina questionnaires) at 10 years post hybrid procedure.
RESULTS: 12 patients were lost to follow and 21 patients died (5 of them were of cardiac-related causes). Of the 57 patients eligible for the study, the average age was 70.649.65. A total of 39 patients thus far have completed 10-year follow-up scans (17 patients are still in progress at this point of abstract submission and will be completed within months). CTA and MPS-MIBI scans of the 37 patients showed a 97% patency of LITA-LAD graft, and 92% stent patency with the mean follow up of 11.75 1.5 years. There were 5 reinterventions required (1 CABG vs 4 PCIs). All of 57 patients have completed the Seattle angina questionnaire, 37/57 (82.6%) of those patients remain angina-free at almost 12 years of follow up. In our series, cardiac related mortality was 5.5% (5/57).
CONCLUSIONS:
Robotic assisted-HCR is a safe and effective strategy for treatment of multivessel coronary artery disease. Our study has demonstrated the superiority of long term LITA-LAD patency rates and an acceptable stent patency rate. With improved patency profiles of newer generations of stent, HCR will continue to become a promising strategy that results in complete revascularization with good long-term patency and high rate of freedom from angina and repeat revascularization.


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