Robotic Assisted Minimally Invasive Direct Coronary Artery Bypass Surgery. A Decade Of A Single Center Experience Of 638 Consecutive Cases.
Zhandong Zhou, Anna Gleboff, Karikehalli Dilip, Ahmad Nazem, Anton Cherney, Joan Dennis, Charles Lutz.
St. Joseph Health Hospital, Syracuse, NY, USA.
BACKGROUND: The Robot has been used in cardiac operations for many years. There have been relatively few large series of Robotically Assisted Coronary Bypass Procedures reported in literature. We present a review of our center’s experience combining Robotic Internal Mammary harvest with Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) technique. METHODS: Patients referred for coronary artery bypass surgery were chosen for robotic assisted MIDCAB at the discretion of the Surgeon/Cardiologist. Robotically assisted mammary artery harvest was performed with the standard three port approach. After the left internal mammary artery (LIMA) and/or the right internal mammary artery (RIMA) was taken down, a small left anterior thoracotomy incision about 6 cm long was performed in the fourth or fifth intercostal space to complete the anastomosis on the beating heart. For multiple vessel bypasses, cardiopulmonary bypass support through femoral artery and vein cannulation was performed without clamping the aorta. More than a third of the total number of patients underwent multivessel grafting. RESULTS: From January 2012 to March 2022, a total of 638 cases were performed.
The Mean age of the patients was 67 years. 72% (462) of the patients were male
9 (1.4%) patients died within 30 days comprising of 7 (1.1%) Urgent/emergent patients and 2(0.3%) elective patients.
6 patients (0.9%) were converted to full conventional sternotomy, all on a planned basis.
Morbidity included Post Operative atrial fibrillation: 18.7% (119), Prolonged ventilation greater than 24 hours: 4.2% (25), Post op bleeding 1.3% (8), Post op renal failure 1% (6) and Wound infection 0.3% (2),
There were no cases of post operative stroke or graft failure.
Total procedure time was 165 ± 54 minutes.
Length of stay in ICU was 72 ± 27 hours
Post operative length of stay was 5.57 days for Elective surgeries and 10.79 days for Urgent Surgeries. CONCLUSIONS:This is one of the largest Robotic Assisted MIDCAB experience in published literature.
Robotic assisted MIDCAB’s can be performed in an experienced robotic surgery center with good outcomes.
Pump assisted robotic MIDCAB may be a more reproducible surgery for multiple vessel bypass.
| Number of Cases | 638 |
| Mean Age (Years) | 67 |
| Gender (% Male) | 462 (72%) |
| Post op Bleeding | 8 (1.3%) |
| Post Op Atrial Fibrillation | 119 (18.7%) |
| Prolonged Ventilation (*>24 hours) | 25 (4.2%) |
| Post Op Acute Kidney Injury (AKI) | 6(1%) |
| Post Op Length of Stay (Mean :days) | 5.57 |
| <30 day mortalty | 9(1.4%) |
| Post op Graft Failure | 0 (0.00%) |
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