Robotic Coronary Revascularization Versus Off-pump Coronary Artery Bypass Grafting: Comparative Effectiveness Analysis
Ali Hage, Fadi Hage, Stephanie Fox, Stuart Swinamer, Reiza Rayman, Michael W.A. Chu, Patrick Teefy, Christopher Harle, Ivan Iglesias, Bob Kiaii.
Western University, London, ON, Canada.
BACKGROUND: Robotic Coronary Revascularization (RCR) is an evolving field that offers a minimally-invasive alternative to treat coronary artery disease. We provide a comparative analysis of RCR to off-pump coronary artery bypass grafting (OPCABG).
METHODS: Our sample consisted of all sternotomy OPCABG (n=395) and RCR (n=319) performed at our institution between January 2008 and July 2017. We performed an adjusted analysis using inverse-probability weighting based on the propensity score of receiving either OPCABG or RCR. The propensity score was calculated using an a priori logistic regression model based on covariates deemed to likely be predictive of the surgical approach used or the outcomes of interest.
RESULTS: RCR was associated with lower rates of in-hospital mortality (OPCABG 6.7% (n=6) vs. RCR 0%, p=0.02), post-operative atrial fibrillation (OPCABG 21.0% (n=83) vs. RCR 7.8% (n=25), p<0.001), respiratory infection (OPCABG 4.3% (n=17) vs. RCR 0.3% (n=1), p<0.001), hemodialysis (OPCABG 1.3% (n=5) vs. RCR 0%, p=0.03), use of intra-aortic balloon pump (OPCABG 1.0% (n=4) vs. RCR 0%, p=0.048), mediastinitis (OPCABG 1.0% (n=4) vs. RCR 0%, p=0.045), and higher post-operative hemoglobin (mean+/-SD) (OPCABG 103.7+/-42.5g/L vs. RCR 114.4+/-16.3g/L, p<0.01). RCR was associated with a higher in-hospital re-intervention rate (OPCABG 0% vs. RCR 3.8% (n=12), p<0.001) attributable to the fact that the patients who underwent RCR had routine postoperative angiographic evaluation of the grafts as opposed to the OPCABG patients. The RCR group had a trend toward shorter hospital length of stay (mean difference -1.2 days, p=0.1). Bothgroups had similar results in terms of re-exploration for bleeding, perioperative myocardial infarction, stroke, lower prolonged mechanical ventilation (>24 hours), blood transfusion.
CONCLUSIONS: In selected patients, RCR appears to be safe and seems to provide excellent short-term outcomes when compared with off-pump CABG. It is associated with improved in-hospital survival, lower post-operative morbidities, and shorter length of stay in the hospital.
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