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Robotic Assisted Hybrid Coronary Artery Revascularization; Program Establishment And Early Experience In The Middle East
Uthman Aluthman, Salman Bafageeh, Mohammed Ashour, Abdulbadee Bogis, Rawan Alamri, AHMED F. ELMAHROUK, Ahmed Jamjoom.
King Faisal Specialist hospital and research center, JEDDAH, Saudi Arabia.

BACKGROUND:Hybrid coronary revascularization (HCR) is an evolving technique that merges the best of surgery and PCI approach for the treatment of multivessel. The surgical component of the procedure is minimally invasive and can be done using robotic technology which avoid the need of sternotomy. Our objective is to study all patients who underwent robotic assisted HCR in King Faisal Specialist Hospital and Research Center in Jeddah to evaluate the feasibility and safety of the procedure to establish the robotic program in KSA.
METHODS: This study is a retrospective chart review focusing on patients who underwent robotic assisted HCR in King Faisal Specialist Hospital and Research Center in Jeddah. Patients data was extracted from the hospital system and move to excel sheet which contains (demographic features, date of surgery, comorbidities, STEMI, NSTEMI, positive stress test, blood transfusion, intraoperative complications. Hospital and ICU LOS, ventilation time, re-intervention, and operation time). The study was approved by the institutional review board of king Faisal Specialist Hospital and research Center # 2020-103. RESULTS: The study included 78 patients ( mean age, 56 years [range, 43 to 72 years]; 93% male) underwent hybrid coronary interventions on an intention-to-treat basis. Robotically assisted procedures were performed using the daVinci SI surgical system (Intuitive Surgical, Inc, Sunnyvale, CA). all patients received single endoscopic coronary artery bypass grafting (Left internal mammary artery to the left anterior descending coronary artery). Percutaneous coronary intervention was carried out for the remaining diseased vessels. (28 patients had PCI to the right coronary artery, 17 patients had PCI to the Circumflex artery and 22 patients had PCI for both). Drug-eluting stents were used in in all PCI procedures. Hospital mortality was 0, average hospital LOS was 12 days and 90% of the patients had no blood transfusion. There was no postoperative complications and major cardiac and cerebral events. The percentage of both surgeries converted to conventional and re-exploration for bleeding was 18%. The average operation time was recorded as 4 hours with an ICU LOS less then 24 hours. CONCLUSIONS:Robotic-assisted HCR enables surgical treatment of multivessel coronary artery disease with minimal trauma, shorter hospital and ICU LOS, shorter recovery time and minimal or no need of blood transfusion. Eventually the effectiveness and safety of the process has been proven by the perfect postoperative complications were recorded.

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