Pericarditis And Inflammatory Response In Robot Assisted Minimal Invasive Coronary Surgery: Old Wine In A New Bottle.
Michiel Algoet, MD, Sadaf Davoudi, BSc, Emanuel Van Onsem, BSc, Jules Janssens, BSc, Anne-Laure Vandevelde, BSc, Jef Van den Eynde, BSc, Wouter Oosterlinck, MD PhD.
KU Leuven - UZ Leuven, Leuven, Belgium.
BACKGROUND:Because of the less aggressive surgical intervention in robot assisted minimal invasive coronary artery bypass grafting (RA-MIDCAB), a lower inflammatory burden is suspected as was seen in off-pump coronary artery bypass grafting (OPCAB) vs on-pump CAB. On the other hand, post-operative pericarditis is frequently reported after RA-MIDCAB, detailed data is currently lacking on its prevalence and its consequences. We evaluate the burden of pericarditis in RA-MIDCAB and compare this to OPCAB. METHODS: We retrospectively included patients undergoing isolated coronary surgery by the OPCAB or RA-MIDCAB technique between January 1st 2015 and June 31st 2021. Primary outcomes are inflammation and pericarditis after surgery. Secondary endpoints are length of hospital stay (LOS), post-operative atrial fibrillation (POAF), need for pleurocentesis, major adverse cardiovascular and cerebrovascular event (MACCE) and mortality. Inflammation is assessed by mean CRP during the first five post-operative days, pericarditis was diagnosed when two of three conditions were present: diffuse ST elevation, pleural effusion and pericardial/pleural pain. RESULTS: In total 1529 patients were included of which 1099 OPCAB and 432 RA-MIDCAB procedures. Propensity score matching was performed which resulted in 2 cohorts of 429 patients. There was a significant higher prevalence of pericarditis in the MIDCAB group (27.7% vs 12.4%, p<0.001), although mean CRP values in the first four postoperative day was significantly lower (p<0.05 ). Signs of pericarditis were treated with colchicine and acetylsalicylic acid in 80% of RA-MIDCAB patients. No cases of constrictive pericarditis has been observed. LOS was significant shorter in the RA-MIDCAB. There was no difference in POAF 28.2% vs. 22.6% (p = 0.071) and pleurocentesis 6.3% vs 5.4% (p=0.66) in MIDCAB vs OPCAB respectively. There was no statistical difference in MACCE (p= 0.33) and mortality (p=0.21) free survival. CONCLUSIONS:In a propensity score matched OPCAB vs RA-MIDCAB cohort we observed a significant higher prevalence of pericarditis. However, this mild form of post-operative pericarditis responds well to treatment in RA-MIDCAB with less inflammation, shorter LOS and similar POAF, pleurocentesis, MACCE and mortality compared to OPCAB.
LEGENDS:Figure 1: A, overall survival analysis. B, Mean postoperative CRP. C, post-operative pericarditis. D, post-operative atrial fibrillation.
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