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Quality Of Life In Patients Undergoing Robotic-assisted Hybrid Coronary Revascularization Vs Conventional Cabg: A Prospective Study
Mohammed Ashour, Salman W. Bafageeh, Uthman Aluthman.
King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
BACKGROUND: Hybrid coronary revascularization (HCR) is an intervention that combines the left internal mammary artery (LIMA)-Left anterior descending (LAD) graft and percutaneous coronary intervention (PCI) to non-LAD vessels, advancements in technology has introduced Robotic-assisted hybrid coronary revascularization (R-HCR), with robotic assisted LIMA harvesting and LIMA-LAD manual anastomosis through a minimally invasive direct coronary artery bypass (MIDCAB) approach as an alternative to conventional coronary artery bypass grafting (CABG) with a sternotomy. While R-HCR has shown similar outcomes to CABG in terms of peri-operative outcomes, various studies have shown that R-HCR was also associated with fewer transfusions, shorter lengths of stay, and lower hospital costs. Given these findings, this study aims to compare the subjective quality of life outcomes at 4 weeks and 6 months post-surgery using the SF36 questionnaire for patients undergoing traditional CABG and R-HCR.
METHODS: A prospective cohort study was conducted, enrolling 96 patients scheduled for either conventional CABG or R-HCR; 48 patients in each group. Quality of life outcomes were compared using the SF36 questionnaire at three time points: pre-operative, 4 weeks, 6 months post-operative. The SF36 questionnaire includes eight domains; providing a comprehensive evaluation of patients' well-being.
RESULTS: 96 patients were included in the study , 48 patients in each group. Findings at 4 weeks, 6 months post-surgery indicate that R-HCR patients demonstrated a statistically significant advantage in certain domains (Physical functioning, role of physical functioning, energy/vitality, pain and general health), suggesting a potential early benefit in quality of life outcomes. Regarding mental health scores, there was no significant difference between group pre-op and at 4 weeks, but R-HCR group showed higher scores at 6 months. Social functioning scores showed a significant difference between groups at 4 weeks, favoring R-HCR group.
CONCLUSIONS: R-HCR offers advantages in terms of rapid recovery and sustained quality of life improvements compared to conventional CABG. MIDCAB approach results in significantly less pain at short and long term. Further research with a larger sample size and long-term follow-up is warranted to validate these findings and inform clinical decision-making in selecting the most suitable surgical approach for patients with coronary artery disease.
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