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International Society For Minimally Invasive Cardiothoracic Surgery

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The Value of Robotic Tecab in Multiarterial Grafting
Gianluca Torregrossa, Sarah Nisivaco, Brooke Patel, Charocka Coleman, Husam H. Balkhy
University of Chicago, Chicago, IL, USA

Objective: Diabetics, who present with coronary artery disease at a younger age benefit the most from multiarterial grafting. However the use of bilateral internal thoracic arteries (BITA) in coronary artery bypass grafting (CABG) via sternotomy is less than 5% in the US general population due to concerns of sternal wound infection. Robotic off-pump coronary bypass grafting (TECAB) avoids sternotomy, maintains the proximity of the RITA to the heart (enhancing its reach), and improves post-operative recovery and length of stay (LOS). This study evaluates outcomes in our diabetic patients undergoing robotic TECAB with two internal thoracic artery grafts.Methods: A retrospective analysis of 101 diabetic patients undergoing BITA TECAB (constituting 18% of 570 TECAB patients) between 7/2013-12/2020 at a single institution was performed. Pre-operative, intraoperative and post-operative results at 30 days and at mean follow-up of 38.0 23.3 months, were analyzed.Results: Mean age was 67 years. Mean STS risk score was 2.02. Fifty percent of patients had BMI ≥30. Mean ejection-fraction was 51.3% and 38% of patients had previous percutaneous intervention. There were no conversions to sternotomy and 49% underwent staged hybrid revascularization. Intraoperative blood transfusion was required in 10% of patients, while femoral cardiopulmonary bypass was necessary in 1 patient to support gas exchange. The mean LITA flow was 76.5 39 ml/min, while mean RITA flow was 72.1 35.2 ml/min using intraoperative trans-time flow measurement. Extubation in the OR occurred in 35% of patients and mean hospital LOS was 3 days. There were no re-explorations for bleeding. At 30 days there was one death due to carotid stent thrombosis. There were no wound infections. At mid-term follow-up, three patients had a cardiac-related mortality and freedom from MI, cardiac reoperation and culprit vessel PCI was 94%.Early graft patency from patients undergoing hybrid revascularization was 97% (70/72 grafts).Conclusions: The adoption of TECAB enhances the use of BITA revascularization in diabetic patients. In the hands of a dedicated robotic coronary team, TECAB BITA is feasible and allows more patients to receive the benefit of multiarterial grafting, particularly those at increased risk of wound infection.


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