Review Of Graft Patency In Robotically Assisted Coronary Artery Bypass And Totally Endoscopic Coronary Bypass Surgery
Elan A. Sherazee, Timothy M. Guenther, Bob Kiaii.
UC Davis Medical Center, Sacramento, CA, USA.
BACKGROUND: Robotically assisted coronary artery bypass grafting surgery (RACABG) avoids the morbidities of a sternotomy and cardiopulmonary bypass and is becoming increasingly popular. Robotically assisted minimally invasive direct CABG (RMIDCAB) and totally endoscopic CABG (TECAB) have been shown to have similar patency rates compared to conventional CABG (Left internal mammary artery patency: 98%, 95%, 88% at 5, 10 and 15 years, respectively). A systematic review was performed to evaluate graft patency and clinical outcomes in patients who underwent RACABG.
METHODS: A systematic review of studies reporting graft patency after RACABG was performed using PubMed, Google Scholar, and Embase.
RESULTS: Between June 1998 and August 2018, 4,344 patients underwent RACABG, either by RMIDCAB (2,662) or TECAB (1,682) approach. Both cohorts were evaluated with post operative CTA or angiogram at similar rates (TECAB 70% vs. RMIDCAB 69%). The average graft patency at short- (<1 month), mid- (<5 years) and long-term (≥5 years) follow up was 97.6%, 95.3% and 94.2% for RMIDCAB, respectively and 98%, 95.6% and 93.7% for TECAB, respectively. Rates of 30-day mortality, conversion to sternotomy and post op reintervention for an occluded graft were 0.3%, 1.5% and 1.6%, respectively.
CONCLUSIONS: RACABG has comparable patency rates to conventional CABG with a low rate of reintervention. Short term patency rates are well documented in the literature; however, there are only a few studies reporting on the mid- and long-term outcomes. Although the initial data is very encouraging, further investigation is warranted to further assess this minimally invasive technique for surgical coronary artery revascularization.
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