Hybrid coronary revascularization: Midterm outcomes of robotic multivessel bypass and percutaneous interventions

Hiroto Kitahara; Taishi Hirai; Mackenzie McCrorey; Brooke Patel; Sarah Nisivaco; Sandeep Nathan; Husam H Balkhy

doi:10.1016/j.jtcvs.2018.08.126

Hybrid coronary revascularization: Midterm outcomes of robotic multivessel bypass and percutaneous interventions

J Thorac Cardiovasc Surg. 2019 May;157(5):1829-1836.e1. doi: 10.1016/j.jtcvs.2018.08.126. Epub 2018 Nov 14.

Authors

Hiroto Kitahara¹, Taishi Hirai², Mackenzie McCrorey¹, Brooke Patel¹, Sarah Nisivaco¹, Sandeep Nathan², Husam H Balkhy³

Affiliations

¹ Section of Cardiac and Thoracic Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, Ill.
² Section of Cardiology, Department of Medicine, The University of Chicago Medicine, Chicago, Ill.
³ Section of Cardiac and Thoracic Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, Ill. Electronic address: hbalkhy@surgery.bsd.uchicago.edu.

PMID: 30635190
DOI: 10.1016/j.jtcvs.2018.08.126

Abstract

Objective: The purpose of this study was to investigate the outcomes of patients undergoing advanced hybrid coronary revascularization, defined as robotic beating-heart multivessel totally endoscopic coronary artery bypass combined with percutaneous coronary intervention.

Methods: This is a retrospective study. Among 308 consecutive patients who underwent totally endoscopic coronary artery bypass, 57 who underwent advanced hybrid coronary revascularization (mean age, 65.6 years) from July 2013 to September 2017 were included. Midterm survival and freedom from major adverse cardiac events, including death, myocardial infarction, and repeat revascularization, were analyzed.

Results: Multivessel totally endoscopic coronary artery bypass was successfully performed without conversion to thoracotomy. Bilateral internal thoracic artery grafting was used in 50 patients (87.7%). The mean operative time was 318.4 ± 51.0 minutes. The mean length of hospital stay was 3.0 ± 1.3 days. There was no 30-day mortality. Percutaneous coronary intervention was planned after totally endoscopic coronary artery bypass in 51 patients (89.4%). The target lesions were the right coronary artery only in 38 patients, the left circumflex artery only in 4 patients, and multiple lesions in 13 patients. Eventually, 2 patients did not receive percutaneous coronary intervention. Percutaneous coronary intervention attempt was unsuccessful in 8 lesions. Patency of the left/right internal thoracic artery was 95.2% (60/63) and 95.7% (45/47), respectively. Graft patency was 95.2% (40/42) in the left circumflex artery and 93.3% (14/15) in the diagonal branch. Three-year survival was 92.8%, and 3-year freedom from major adverse cardiac events was 80.2%.

Conclusions: Advanced hybrid coronary revascularization is a safe and less-invasive approach with short hospital stay and good midterm outcomes.

Keywords: PCI; TECAB; hybrid revascularization; robotic.

Publication types

Webcast

MeSH terms

Aged
Combined Modality Therapy
Coronary Artery Bypass / adverse effects
Coronary Artery Bypass / methods*
Coronary Artery Bypass / mortality
Coronary Artery Disease / diagnostic imaging
Coronary Artery Disease / mortality
Coronary Artery Disease / surgery
Coronary Artery Disease / therapy*
Endoscopy* / adverse effects
Endoscopy* / mortality
Female
Humans
Length of Stay
Male
Middle Aged
Operative Time
Percutaneous Coronary Intervention* / adverse effects
Percutaneous Coronary Intervention* / mortality
Postoperative Complications / mortality
Postoperative Complications / therapy
Progression-Free Survival
Retreatment
Retrospective Studies
Risk Factors
Robotic Surgical Procedures* / adverse effects
Robotic Surgical Procedures* / mortality
Time Factors
Vascular Patency