Non Lad Territory Revascularization In Robotic Totally Endoscopic Coronary Bypass: Second Arterial Graft Vs Hybrid Stent
Sarah Nisivaco, Hiroto Kitahara, Sandeep Nathan, Husam H. Balkhy.
University of Chicago Medicine, Chicago, IL, USA.
BACKGROUND: Benefits of hybrid revascularization with arterial grafting of LAD territory and percutaneous coronary intervention (PCI) to non-LAD territory are well-established. Another approach is multivessel totally-endoscopic coronary bypass (TECAB) to revascularize LAD and non-LAD territory. We compared the outcomes of arterial grafting vs. PCI to non-LAD territory in patients undergoing robotic TECAB. METHODS: 700 patients underwent beating-heart robotic TECAB between 7/2013-7/2022. Of these, 275 had LAD disease (anterior wall) in addition to one other territory (lateral or inferior wall) disease. All patients underwent robotic off-pump coronary revascularization of their anterior wall (with LITA or RITA) and were divided into 2 groups based on the revascularization strategy of the second (non-LAD) territory. Group-1 (168 patients) received an arterial graft to the non-LAD territory at the time of index TECAB; Group-2 (107 patients) underwent staged PCI of the non-LAD territory before or after TECAB. Early and mid-term clinical outcomes were analyzed. Primary outcomes included mortality, major adverse cerebral/cardiovascular events (MACCE), and re-intervention.
RESULTS: Demographics were similar. Group-1 had higher incidence of ejection fraction <40% (23% vs 13%, p=0.038). There was no difference in STS mortality risk. In Group-1, BITA was used in 97% of patients. In Group-2, LITA was used in 96% and RITA in 4%, respectively, for LAD revascularization.In Group-1, the non-LAD territory revascularized with arterial grafting was the lateral wall (LCx/OM) in 94.6% and inferior wall (RCA/PLB) in 5.4%. In Group-2, the non-LAD territory revascularized by PCI was the lateral wall in 39% and inferior wall in 61%. There was no difference in extubation time, blood transfusions, or hospital stay. Postoperative atrial fibrillation, pericarditis, stroke, MI, and mortality were not different. Mid-term clinical follow-up at 43 months showed no difference in mortality (all-cause or cardiac-related), repeat cardiac surgery, MI, or MACCE (Table-1). Repeat revascularization was lower in Group-1 versus Group-2 (3% vs 11%, p=0.006). CONCLUSIONS:In patients undergoing beating-heart robotic TECAB with a graft to the LAD, a second arterial graft to a non-LAD target was associated with lower repeat revascularization compared to hybrid PCI. Other outcomes (early and midterm mortality, MI, stroke, and MACCE) were similar. Further studies are warranted.
Back to 2023 Abstracts