Outcomes Of Single Vessel And Multiple Vessel Disease In Robotic Assisted Minimally Invasive Direct Coronary Artery Bypass
Zhandong Zhou, Anna Gleboff, Karikehalli Dilip, Ahmad Nazem, Anton Cherney, Joan Dennis, Charles Lutz.
St. Joseph's Health Hospital, Syracuse, NY, USA.
BACKGROUND: Robotic assisted coronary artery bypass surgeries have been mainly performed for single vessel disease. Robotic assisted multiple vessel bypass operations have not been popular due to technical challenges resulting in scant literature on the subject. We present our results of Robotically assisted Single Vessel and Multi Vessel grafting. METHODS: From January 2012 to March 2022, a total of 637 patients underwent Robotic assisted harvest of Internal Mammary artery/s and Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) through a small left anterior thoracotomy in our hospital. Data was collected from Society of Thoracic Surgeons (STS) reports. 23 patients were excluded from the study due to emergency surgery and/or were hemodynamically unstable on Mechanical Circulatory Support. 614 patients remained in the study after exclusions. Patients were grouped into single vessel disease (n=505) and multivessel (two or three vessel) disease groups (n=109). The two groups were matched with no significant difference with regards to the patients’ gender, Diabetes mellitus, Left Ventricular Ejection Fraction, elective vs urgent operations, prior PCI, peripheral vascular disease, preoperative renal disease, body mass index or Congestive Heart Failure.Data was compared between groups using chi-squared test and T-Test. RESULTS: The single vessel disease group of 505 patients received an average of 1.25 grafts, while 109 patients in the Multivessel group received an average of 2.47 grafts.
The single vessel disease group had more patients with planned PCI (HYBRID), and later extubation times.
The multiple vessel group had older patients, and more cerebral vascular disease and more post operative atrial fibrillation.
There was no significant difference in the outcomes between the two groups with regards to reoperation for bleeding, post operative renal failure, post operative hospital length of stay or 30-day mortality.SEE ATTACHED TABLE BELOW
CONCLUSIONS: Robotic assisted multi vessel MIDCAB can be performed safely with comparable results to single vessel bypass in an experienced center. We present one of the largest series of such cases in published literature with good outcomes. With complex comorbidities, an aging population, and the demands for a quick recovery Robotic assisted multiple vessel MIDCAB may be a valuable tool.
| SINGLE VESSEL (n=505) | SINGLE VESSEL (n-505) | MULTI VESSEL (n=109) | MULTI VESSEL (n=109) | p-value | ||
| Age (years) | (Mean+/-SD) | 66.33 | +/-12.02 | 69.90 | +/-9.20 | <0.001 |
| Gender (Male) | (Yes%) | 363 | 71.88% | 82 | 75.23 | 0.478 |
| Cerebrovascular disease | (Yes%) | 123 | 24.36% | 38 | 34.86 | 0.024 |
| Extubated (<6hrs) | (Yes%) | 148 | 29.31% | 79 | 72.48% | <0.001 |
| Post Op AFib | (Yes%) | 83 | 16.44 | 29 | 26.61 | 0.013 |
| Reop Bleeding | (Yes%) | 4 | 0.79% | 2 | 1.83 | 0.316 |
| LOS (Days) | (Mean+/-SD) | 7.58 | +/-5.32 | 8.60 | +/-4.77 | 0.65 |
| Post Op AKI | (Yes%) | 3 | 0.59% | 0 | 0.00% | 0.42 |
| 30 day Mortality-Alive | (Yes%) | 500 | 99.01% | 109 | 100% | 0.297 |
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