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International Society For Minimally Invasive Cardiothoracic Surgery

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Outcomes Of Robotic Totally Endoscopic Coronary Artery Bypass In Patients With End-stage Renal Disease On Hemodialysis
Sarah Nisivaco, Brooke Patel, Kaitlin Grady, Husam H. Balkhy.
University of Chicago Medicine, Chicago, IL, USA.

Objectives End-stage renal disease (ESRD) has a negative impact on outcomes in patients undergoing coronary artery bypass surgery (CABG). We hypothesized that robotic-assisted totally-endoscopic beating-heart coronary bypass (TECAB) would result in improved outcomes for these patients. The objective of this study was to evaluate outcomes in our ESRD patients on hemodialysis (HD) undergoing TECAB. Methods From 7/2013-12/2019, a total of 486 patients underwent robotic TECAB at our institution; 22 were on hemodialysis for ESRD. We performed a retrospective review of peri-operative and mid-term outcomes. All cases were performed by the same experienced robotic surgeon and team using the da Vinci Si system and Endowrist stabilizer. Exclusion criteria for beating-heart TECAB were emergency surgery, cardiogenic shock, and fused left chest, but not ESRD. Results The 22 patients in the HD-group had mean STS score of 6.16 + 6.5. Mean age was 60 years with 41% female patients. The non-HD group had 464 patients with mean STS score of 1.47 + 2.1, mean age 66 years, and 25% female patients. The HD-group had predictably higher rates of hypertension, PVD, diabetes, BMI, and CHF. The incidence of postoperative atrial fibrillation, stroke, MI, wound infection, and length of stay were similar between the groups. The incidence of prolonged ventilation (>24h) was similar, however extubation in the OR was less in the HD-group (5% vs 49%, p=0.000). Perioperative blood transfusion was higher in the HD-group (50% vs 14%, p=0.004). Mortality and takeback for bleeding were lower in the HD-group (0% vs 1.1%, p=0.025l; 0% vs 1.1%, p=0.025, respectively). Table 1. 2-year cardiac-related death and freedom from MACE events were similar (6% vs 3%, p=0.558, and 82% vs 92%, p=0.133, respectively). Conclusions The benefits of CABG over percutaneous coronary intervention in ESRD have been demonstrated, including lower mortality. However, historically ESRD confers a higher risk in patients undergoing conventional coronary artery bypass grafting. Our study demonstrates that mid-term outcomes of beating-heart robotic TECAB in ESRD patients on HD with coronary artery disease were comparable to patients with normal renal function, and are superior to outcomes of traditional CABG in this challenging group of patients. Further long-term studies are warranted.
Table Header: Table 1: Postoperative TECAB outcomes comparison between HD patients and non-HD patients Table Legend: OR: operating room; LOS: length of stay; ICU: intensive care unit


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