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International Society For Minimally Invasive Cardiothoracic Surgery

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Hybrid Coronary Revascularization: Early Outcomes And 7 Year Follow-up In Patients Undergoing Single Or Multivessel Robotic Tecab And Pci
Sarah Nisivaco, BS, Hiroto Kitahara, MD, Gianluca Torregrossa, Sandeep Nathan, MD, Husam H. Balkhy, MD.
University of Chicago Medicine, Chicago, IL, USA.

BACKGROUND: Hybrid coronary revascularization (HCR) is defined by the integration of sternal sparing CABG and PCI in patients with multivessel CAD. It is traditionally performed with a single bypass (LIMA-LAD) and PCI but can also be accomplished with multiple arterial grafts using bilateral IMA conduits. We sought to review our HCR experience over a 7-year period using a robotic TECAB approach and PCI. METHODS: Of 570 patients undergoing beating-heart TECAB between 8/2013 to 12/2020, 250 patients were designated to receive HCR and are the subject of this review. Patients underwent percutaneous coronary intervention (PCI) with drug-eluting stents before, simultaneous, or after TECAB using single or bilateral internal mammary arteries (BIMA). We retrospectively reviewed early and midterm outcomes up to 6 years in this cohort of intention-to-treat (ITT) HCR patients. RESULTS: Mean age was 65+10 years and 55 patients (22%) were female. Mean STS PROM was 1.68+2.7. 41 patients (16%) had >70% left-main disease, and 180 patients (72%) had triple-vessel disease. 160 patients (64%) underwent multivessel grafting (advanced HCR), with 84% BIMA use in this group. Mean operative time was 263+81 minutes, and mean LOS was 2.7 days. Mean number of vessels bypassed per patient was 1.72; mean number of vessels stented was 1.15+0.4. 81% of patients had TECAB first, 16% had PCI first, and 3% had simultaneous TECAB/PCI. In the TECAB first group, 9 patients had an unsuccessful attempt at PCI; 20 patients did not undergo PCI because of a change in management plan (due to negative stress test postoperatively or because the target intended for PCI was grafted during TECAB); 13 patients declined PCI after TECAB. Early mortality was 0.8% (O/E: 0.48%). Early graft patency was 97% (264/273 grafts); LIMA-LAD patency was 98%. At 6-year follow-up (mean 33+22 months), all-cause and cardiac-related mortality were 12% and 2.8%, respectively. Freedom from MACE was 93%. CONCLUSIONS:In patients with multivessel CAD, integrating robotic single and multi-vessel TECAB with PCI resulted in excellent early and midterm outcomes. The robotic endoscopic approach allows the routine use of multiple arterial grafting during HCR in experienced hands. Further studies are warranted.
Figure 1 LEGEND: Cardiac Survival and Freedom from MACE in 250 Hybrid Coronary Revascularization Patients

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