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International Society For Minimally Invasive Cardiothoracic Surgery

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20-year Single-center Experience Of Robotic-assisted Coronary Artery Bypass Grafting: Long-term Follow-up And Graft Patency.
Yehia Moharrem1, Alireza Jalali1, Jonathan Hu1, Stephanie Fox1, Stuart Swinamer1, Reiza Rayman1, Kim Chai Chua1, Christopher Harle1, Phillip Jones1, Wojciech Dobkowski1, Jonathan Romsa1, William Vezina1, Michael Chu1, Patrick Teefy1, Alan Menkis2, W Douglas Boyd3, Bob Kiaii4.
1London Health Science Research Center, London, ON, Canada, 2St. Bonafice General Hospital, Winnipeg, MB, Canada, 3East Carolina University, Greenville, NC, USA, 4UC Davis Health, Sacramento, CA, USA.

BACKGROUND: Minimally Invasive coronary artery bypass grafting (CABG) is a rapidly evolving technology that has been shown to increase patient satisfaction and reduce surgical morbidity and recovery times. Robotic assisted-CABG (RA-CABG) offers an alternative minimally invasive option for patients with coronary artery disease, which avoids sternotomy and cardiopulmonary bypass. However, the long-term graft patency and clinical outcomes of RA-CABG remain elusive. The objective of this study is to assess long term clinical outcomes and graft patency of patients who underwent RA-CABG.
METHODS: : 645 patients who underwent RA-CABG from July 1998 to December 2018 were enrolled in this study. All patients underwent robotic assisted left internal thoracic artery (LITA) to left anterior descending artery (LAD) grafting. Of the 645 patients, 89 patients had hybrid revascularization involving percutaneous coronary intervention (PCI) to non-LAD vessels. At a mean follow-up of 10 7 years, patients underwent computed tomography angiography (CTA) and myocardial perfusion scintigraphy (MPS-MIBI) at rest and with stress to assess perfusion and functionality respectively. Patients also completed quality-of-life questionnaires to assess freedom from angina.
RESULTS: The mean age in the study was 70 12 years (173 (26.8%) females and 472 (73.2%) males). There were no in-hospital or 30-day mortalities. There were 63 (9.7%) late deaths, where 8 were cardiac-related. To date, 86 patients have completed follow-up scans (496 patients are still in progress). CTA and MPS-MIBI scans of the 86 patients showed a (82/86) 95.3% patency of the LITA-LAD graft, at a mean follow up of 13 7 years. Repeat revascularizations due to a failed graft were required in 2/123 patients (1.6%). To date, 110 patients have completed quality-of-life questionnaires, and 109/123 (88.6%) patients remain angina-free at the time of follow up.
CONCLUSIONS:RA-CABG is a safe and effective strategy for the treatment of coronary artery disease. Our study has demonstrated that RA-CABG is efficacious with excellent long-term graft patency. This minimally invasive strategy has shown promising results, allowing complete revascularization with good long-term outcomes, and a high rate of freedom from angina and repeat revascularization.

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