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Midterm Outcomes Of Robotic Assisted Total Arterial Revascularization In Patients With Multivessel Coronary Artery Disease
Meeranghani Mohammed Yusuf, Varun Bansal, Kavyapriya PA, Aishwarya Mahesh Kumar.
Apollo Hospitals, Chennai, India.
Objective: Total arterial revascularization using bilateral internal mammary artery grafting has shown to reduce re-intervention and improve survival in patients with multi-vessel coronary artery disease (CAD). Robotic cardiac surgery over years has demonstrated superior outcomes by not only expediting patient recovery but also significantly reducing the incidence of post-operative complications. The objective of this study is to present the midterm outcome of robotic-assisted coronary artery bypass grafting (CABG) with total arterial revascularization performed in a high-volume cardiac surgery centre, in India.
Methods: This is a retrospective analysis of patients who underwent Total Arterial Revascularization using robot assisted CABG for multi-vessel CAD at Apollo Hospitals, Chennai, India. In-hospital outcomes included mortality, length of intensive care unit, post-operative stay in the hospital, and perioperative morbidity. Analysis of mortality and major adverse cardiac and cerebrovascular outcomes was performed at 5 year follow up.
Results: Over a 6-year period, 376 patients [86.9% male, mean age of 60.82 ± 9.98 years, of which 20.47% (n=77) were >70 years of age] underwent robotic assisted CABG with total arterial revascularization. A significant proportion 73.13% (n=275) had diabetes mellitus, and 11.43% (n=43) patients had chronic kidney disease. 18.8% (n=71) individuals had poor LV function prior to surgery. The rate of conversion to open sternotomy was 0.79% (n=3). Postoperatively, 6 patients experienced complications,
ie, atrial fibrillation, pleural effusion. The in-hospital mortality was 1.06% (n=4). Notably, these patients were multi-morbid and had significantly high EuroSCORE, necessitating surgery under high-risk consent. 56.9% (n=214) of patients did not require post-operative transfusion. The average length of intensive care unit stay was 2.68 ± 0.94 days and the average length of in-hospital stay post-surgery was 5.91 ± 2.79 days. At 5 year follow up, all-cause mortality was 1.59% (n=6). 6 patients required re-intervention with percutaneous coronary intervention and 1 patient had redo-surgery.
Conclusion: Robot-assisted coronary artery bypass grafting with total arterial revascularization is a safe, feasible alternative to traditional coronary artery bypass grafting. Young Diabetic patients and elderly with co morbidities benefit more by the procedure. To further assess the potential benefits of this technology and expand its application, multi-centre randomized trials are necessary.
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