Clinical Outcomes Of A Surgeon In The First Year Of Robotic Coronary Revascularization Independent Clinical Practice.
Aleksander Dokollari1, Serge Sicouri2, Ozgun Erten1, Basel Ramlawi1, Leila Hosseinian1, Francis Sutter1, Gianluca Torregrossa1.
1Lankenau Medical Center, Wynnewood, PA, USA, 2Lankenau Institute for Medical Institute, Wynnewood, PA, USA.
BACKGROUND: To have good outcomes in your clinical practice the surgeon necessitates an appropriate training in a specialized center. • The debate if coronary surgery should be the "bread and butter" of every heart surgical center or a niche has been very active in scientific literature. No outcomes of trainees who dedicated a specific time to train in coronary surgery has ever been investigated. • We aim to analyze the first 12-months clinical outcomes of two different populations a) isolated conventional CABG and b) robotic-assisted CABG done by a staff surgeon in the first year of clinical practice. In addition, we want to emphasize the importance of an appropriate training in achieving good results. METHODS: • This is an observational cohort study of consecutive patients undergoing CABG at our institute between June 2021- August 2022. Patients were included by all demographics and preoperative characteristics in two groups (standard and robotic-assisted). • Procedure characteristics included off-pump vs on-pump, type of CABG (multi-arterial, total arterial), saphenous vein grafts (SVG) used, number of grafts, robotic-assisted CABG, conversion rate to full sternotomy, reverse HCR, COR-KNOT Micro use, cryoablation pain therapy, and surgery priority. • Primary outcome was description of clinical outcomes and angiographic findings for each patient population (standard and robotic-assisted CABG) undergoing isolated CABG procedure. • Secondary outcomes were: overall death, cardiac death, repeat revascularization, stroke, angina, myocardial infarction (MI), and MACCE. RESULTS: • 192 consecutive patients received CABG that was performed by a single surgeon who recently joined the team. Out of these, 104 patients received robotic-assisted CABG. • The STS score was 1.8 ± 2.9 for the total group of patients and 1.5 ± 1.7 for the robotic-assisted group. Diabetes was present in 42.2% and 34.6% in the total and robotic cohort, respectively. • Use of a second arterial conduit was 40% of the sternotomy group, radial artery graft use was 28% in the conventional and 2.9% in the robotic group. Right internal mammary artery use was 12% in the conventional and 1.9% in the robotic group. In the robotic group no conversion to full sternotomy was done. Off-pump CABG was performed in 99% of all comers. • In the robotic group, the percentage of patients extubated in the operating room was 86.5%, iceCryoTM device use was 55.7%, COR-KNOT Micro use was 25%, and reverse hybrid was 19.2%. • There was no in-hospital death and there was one deaths at 30-days follow-up due to complication of pericardial effusion. • Cardiac readmission was 9% in standard and 11.5% in robotic groups, and overall death was 0.8%. In the hybrid group who received planned post-operative angiography patency of the left internal thoracic artery was 100%. Early (within 30 days) revascularization was 0 in both groups, stroke was 0.5% in the standard and 0% in the robotic group, MI was 0.5% in the standard and 0% in the robotic-assisted group, and MACCE was 1.5% in the standard and 0.9% in the robotic-assisted group. - At one year there was one death in the conventional sternotomy group and one target vessel revascularization in the robotic CABG group. CONCLUSIONS:• After a complete dedicated training in CABG, clinical outcomes are solid with a very low incidence of mortality for all comers, high usage of advances coronary techniques including multi arterial, composite grafts (Y,T,I), robotic CABG. • In addition, there is a high use of a second arterial conduit in sternotomy patients. ( 4 times higher than general STS report) • Heart-team collaboration with the cardiologist as well as a dedicated team of experienced off-pump anesthesia and perfusionist and intensivists is also crucial in achieving excellent results. 
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