Discharge In Post Operative Day 2 Tecab: A Single Center Experience Of More Than 200 Patients
Brooke Patel, Gianluca Torregrossa, Sarah Nisivaco, Charocka Coleman, Husam H. Balkhy.
University of Chicago, Chicago, IL, USA.
BACKGROUND: Outcomes of CABG are of great importance for every Cardiac Surgical Program. Robotically assisted total endoscopic coronary artery bypass grafting (TECAB) represents the optimal surgical approach for ultrafast track protocol and an early post operative discharge while offering single or multiarterial bypass grafting. We present our experience with 229 TECAB discharged in day 2 after surgery. METHODS: We retrospectively evaluated outcomes of 500 patients undergoing single and multivessels TECAB from 7/2013 to 7/2019 in a single Institution. Two-hundred twenty-nine patients (46%) were discharged within POD 2, including 40 patients discharged in POD 1. Pre operative, intraoperative and post operative results and adverse events were analyzed with a mean follow up time of 24 ± 17 months including extubation time, chest tube drainage, mortality, discharge destination, 30 days readmission rates, return to normal activities and angiographic graft patency in 32% patients who underwent a planned hybrid revascularization. RESULTS: Mean age was 63 ± 9.8 years. Mean STS score was 1.07. Fifty six patients were female, 97 patients had triple vessels disease and 15% presented with EF less than 40%. Three percent of patients had prior cardiac surgery and 15% had chronic renal failure. Ninty-five patients received BITA grafting, 64% received multivessels CABG and 1.3% required cardiopulmonary bypass during the case. One hundred thirty-six patients were extubated in the OR, 3.5% received post operative blood transfusion. Eight patients develop a pleuric effusion and 0.4% required re exploration for bleeding. At thirty day, no stroke, TIA, wound infection or Myocardial infarction were observed and overall mortality was 0.43%. At follow up, the overall mortality was 4% with a cardiac related mortality occurred in 2 patients. One patient had repeat cardiac surgery and 72 patients (31%) had a post operative angiograms on an average time of 5.6 ± 11 months after surgery. Graft patency was observed in 95% patients. Overall freedom from MI, cardiac reoperation and culprit vessel PCI was 97%. CONCLUSION In a selected group of patients with coronary artery disease, TECAB allows safe discharge within POD 2 after coronary revascularization. In a center of excellence for robotic cardiac surgery, adoption of TECAB and UltraFT protocol enhance outcomes of CABG while offering minimally invasive multivessels multiarterial coronary revascularization.
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