Sutured vs Stapled Coronary Anastomosis In Robotic Tecab: Does the Anastomotic Technique Matter?
Sarah Nisivaco, BS, Makoto Hashimoto, MD, Gianluca Torregrossa, MD, Brooke Patel, Husam H. Balkhy, MD
University of Chicago Medicine, Chicago, IL, USA
BACKGROUND: In robotic off-pump TECAB, the anastomosis is the most critical part of the procedure. In our experience, an automated distal anastomotic stapler was the primary anastomotic technique until it became commercially unavailable, when we switched to a sutured approach. We sought to compare between these two anastomotic techniques by reviewing outcomes in all patients undergoing bypass grafting with exclusively one of these two approaches. Because the stapler can only create an end-to-side anastomosis, we compared this group to patients receiving solely end-to-side grafts created using a sutured technique. METHODS: From 8/2013-12/2020, 570 patients underwent beating-heart TECAB. 464 patients received isolated end-to-side arterial grafts with single or bilateral internal mammary artery (IMA) conduits using exclusively one of the two techniques and are the subject of this study. 106 patients who received a combination of the two techniques, or received sequential or Y grafting, were excluded. Group-1 (315 patients, 470 grafts) underwent grafting using exclusively the C-Port Flex-A device (Aesculap, Tuttlingen Germany). Group-2 (149 patients, 210 grafts) underwent grafting using exclusively a sutured anastomosis (CV-8 Gore-Tex (Gore, USA) or 7-0 Pronova (Johnson and Johnson Medical, USA)). RESULTS: Preoperative characteristics were similar. In Group-1, 470 end-to-side grafts were constructed using the Flex-A device in 315 patients. In Group-2, 210 end-to-side sutured anastomoses were constructed in 149 patients (49% vs 41% multivessel, respectively; p=0.960). Operative time was shorter in Group-1 (230+80 min vs. 264+85 min; p<0.001). The number of LIMA conduits used and LIMA-LAD grafts were similar (63% vs 63% and 72% vs 68%; p=0.084 and p=0.468, respectively). Graft flows were higher in Group-2 (LIMA: 81+38 vs 95+50 ml/min, p=0.001; RIMA: 71+32 vs 84+41 ml/min, p=0.006). Hospital LOS was longer in Group-1 (2.9 vs 2.3 days; p<0.001). There was no difference in mortality (O/E mortality: 0.7 vs 0.5; p=0.516) or MACE. From hybrid angiographic data, early patency was 97.0% vs 97.6% (p=0.774). CONCLUSIONS: During robotic beating-heart TECAB, grafts constructed using either an automated stapler or sutured technique were equivalent in producing excellent graft patency and clinical patient outcomes. A sutured anastomotic technique was associated with longer operative times. Further studies are warranted.