Robotic Beating-heart Totally Endoscopic Coronary Artery Bypass: Impact Of Chest Wall Dimensions In Single And Multivessel Bypass
Tatsuya Watanabe, Hiroto Kitahara, Charocka Coleman, Brooke Patel, Husam H. Balkhy.
The University of Chicago Medicine, Chicago, IL, USA.
BACKGROUND: Minimally invasive approaches have been widely accepted in cardiac surgery. Advantages include early postoperative recovery, lower risk of bleeding and no risk of sternal infection. However, there can be anatomical constraints on patient selection for minimally invasive surgery. For example a cardiothoracic ratio (CTR) of >50% and an anterio-posterior and lateral diameter (AP/lateral) ratio of <0.45 have been reported to be exclusion criteria for robotic-assisted coronary artery bypass. We perform robotic totally endoscopic coronary artery bypass (TECAB) routinely on all comer basis without strict anatomical exclusion criteria, with a low conversion rate. We sought to examine the impact of chest wall anatomic parameters on operative time in our TECAB procedures.
METHODS: We retrospectively reviewed patients undergoing robotic TECAB all of whom had a preoperative chest radiograph at our institution from July 2017 to October 2021. The cohort was divided into 2 groups: patients undergoing single vessel grafting using the left internal thoracic artery (ITA) (Group1), and patients undergoing Multivessel grafting with bilateral ITA grafts (Group2). We measured several anatomical parameters from the preoperative chest radiograph. On the postero-anterior image 3 measurements were made: the vertical diameter from the lung apex to the diaphragm, the lateral diameter of the ribcage, and the CTR. On the lateral view 2 measurements were made: the sternum-vertebrae anteroposterior diameter (SV-AP) and lung anteroposterior diameter (L-AP). The AP/lateral ratio was calculated with SV-AP and thoracic lateral diameter. Spearman's rank correlation analysis was used to analyze the correlation of each item.
RESULTS: A total of 223 patients undergoing TECAB were retrospectively analyzed. There were no intra-operative conversions to sternotomy. Three patients required readmission and 30-day mortality was 0. In Group1 (n=112), no parameters correlated with operative time (CTR: p=0.124, AP/lateral: p=0.934, SV-AP: p=0.536, L-AP: p=0.818). In Group 2, a significant negative correlation was observed between SV-AP (-0.228, p=0.022), L-AP (-0.246, p=0.013), and operative time. Other parameters showed no significant correlations.
CONCLUSIONS: In single vessel robotic TECAB, chest wall anatomic parameters measured on chest radiograph did not affect operative time. In multivessel cases with bilateral ITA larger AP diameter correlated with shorter operative times.
Back to 2023 Abstracts