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Robotic Assisted Minimally Invasive Coronary Revascularization: Midterm Results
Gökhan Arslanhan
1,
Zeynep Sıla Özcan2, &#
350;ahin &#
350;enay
1, Murat Ba&#
351;topçu
3, Muharrem Koçyi&#
287;it
4, Aleks De&#
287;irmencio&#
287;lu
5, Deniz Can Ali&#
351;
6, Cem Alhan
1;
1Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey,
2Acibadem University School of Medicine, Istanbul, Turkey,
3Dr. Siyami Ersek Research and Training Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey,
4Acibadem University School of Medicine, Department of Anesthesiology, Istanbul, Turkey,
5Acibadem Maslak Hospital, Department of Cardiology, Istanbul, Turkey,
6Acibadem University School of Medicine, Department of Radiology, Istanbul, Turkey
BACKGROUND: Robotic assistance addds many advantages both for the surgeon and the patient to the minimally invasive coronary bypass surgery such as harvest of a longer portion of the LIMA and it offers a less invasive and effective approach for multivessel revascularization and accelerated recovery. We present our midterm clinical outcomes of robotic-assisted minimally invasive coronary bypass cases in our center.
METHODS: Between April 2010 and December 2023, 126 consecutive patients who underwent RCAB were included. Pre-operative patient demographics, perioperative and post-operative data of the patients were retrospectively collected and analyzed. The mean age of the patients was 61.5 ± 9.7 years, and 100 patients were male (79.0%). The mean EuroSCORE of the patients was 2.1 ± 1.9. Robotic assisted LIMA harvest was performed for all patients. Among 126 patients, 52(41%) were operated off-pump. 10 patients among those operated off-pump underwent robotic totally endoscopic coronary artery bypass surgery (TECAB). In the remaining 74 patients, axillary cannulation was the choice of perfusion in 40(32%) because of prohibitive findings in the iliac vessels and aorta, and femoral cannulation in 34(27%). The mean cross- clamp times were 61.3 ± 29.0 mins and cardiopulmonary bypass times 124.4 ± 65.3 mins. The main outcome measure was the midterm survival and the incidence of major adverse cardiovascular events (MACE) up to five years. MACE was defined as coronary reintervention, cerebrovascular event or mortality.
RESULTS: The mean number of revascularized vessels was 2.1 ± 1.2. The left internal mammary artery (LIMA) was anastomosed to the LAD in all patients, and the LIMA was anastomosed sequentially to the diagonal artery in 20 patients (16%). The mean mechanical ventilation time was 4.9 ± 2.8 hours. The mean intensive care unit stay was 20.2 ± 7.3 hours and the mean hospital stay was 6.9 ± 2.6 days. The mean chest tube output was 413.6 ± 397.1 mL. The median follow-up was 17 months. No early complications in the post-operative 30-day period were observed except in one patient who underwent reoperation due to bleeding. The late mortality was observed in 4(3.3%) patients and 2 patients among them were lost due to non-cardiac reasons. MACE was observed in 9(7.4%) patients. In Kaplan-Meier survival analysis, 1-year survival was 99.1% and 5-year survival was 97.5%. In Kaplan-Meier analysis, 1-year freedom from major adverse cardiovascular events (MACE) was 97.3% and 5-year freedom from MACE was 95%.
CONCLUSIONS: Robotic-assisted minimally invasive coronary bypass surgery has safe midterm outcomes and can be performed with excellent results.
Figure 1: Kaplan Meier analyses for 1-year and 5-year survival; 1-year and 5-year freedom from major adverse cardiovascular events (MACE).
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