534 Robotically assisted MIDCAB surgery may have similarly favourable outcomes in high risk and low risk patients

Abstract

BackgroundThe daVinci Robot has facilitated minimally invasive direct coronary artery bypass (MIDCAB) surgery, thereby avoiding the morbidity associated with sternotomy and cardiopulmonary bypass. At our centre, some patients referred for robotically assisted (RA) MIDCAB were at high risk for standard coronary artery bypass graft (CABG) surgery and had no viable percutaneous coronary intervention (PCI) option. These patients seemed to have outcomes comparable to low risk patients. We therefore compared the short-term results of high risk patients with low risk patients undergoing RA MIDCAB surgery.MethodsThirty consecutive patients underwent RA MIDCAB from May 2009 to February 2011. Most patients had single vessel disease in the left anterior descending (LAD) while others had multivessel disease amenable to MIDCAB to the LAD and PCI to other coronary arteries. Harvesting of the left internal mammary artery was performed without sternotomy using the daVinci Robot, followed by bypass of the LAD without cardiopulmonary bypass through a 5cm left thoracotomy incision. The cohort was stratified into high risk groups (first quartile by euroSCORE or STS score) and low risk groups (lowest third quartiles by euroSCORE or STS score). Operative parameters, postoperative complications, 30 day stroke and all-cause mortality were studied.ResultsThe median age of the entire cohort was 68 years old and 73% were male. There were no deaths or strokes at 30 days, however one low risk patient was converted to a sternotomy CABG. Using the euroSCORE, 10 patients were identified as high risk and 20 patients as low risk (6% vs. 2%, P < 0.0001). There was no difference in operative time (258 minutes vs. 242 minutes, P= 0.15), hospital length of stay (5.5 days vs. 4.5 days, P = 0.32) or postoperative complications between the high and low risk patients. When the cohort was stratified by STS score, 8 patients were identified as high risk and 22 patients as low risk (3.2% vs. 0.5%, P < 0.0001). Again, there was no difference in operative time (263 minutes vs. 249 minutes, P = 0.27), hospital length of stay (7 days vs. 4.5 days, P = 0.12) or postoperative complications.ConclusionRA MIDCAB provided the benefits of minimally invasive surgery to both high and low risk patients, with no deaths or strokes at 30 days and only a few minor postoperative complications. These results suggest that RA MIDCAB may be particularly beneficial for patients at high risk for standard CABG surgery or PCI, since they had comparable outcomes to low risk patients. BackgroundThe daVinci Robot has facilitated minimally invasive direct coronary artery bypass (MIDCAB) surgery, thereby avoiding the morbidity associated with sternotomy and cardiopulmonary bypass. At our centre, some patients referred for robotically assisted (RA) MIDCAB were at high risk for standard coronary artery bypass graft (CABG) surgery and had no viable percutaneous coronary intervention (PCI) option. These patients seemed to have outcomes comparable to low risk patients. We therefore compared the short-term results of high risk patients with low risk patients undergoing RA MIDCAB surgery. The daVinci Robot has facilitated minimally invasive direct coronary artery bypass (MIDCAB) surgery, thereby avoiding the morbidity associated with sternotomy and cardiopulmonary bypass. At our centre, some patients referred for robotically assisted (RA) MIDCAB were at high risk for standard coronary artery bypass graft (CABG) surgery and had no viable percutaneous coronary intervention (PCI) option. These patients seemed to have outcomes comparable to low risk patients. We therefore compared the short-term results of high risk patients with low risk patients undergoing RA MIDCAB surgery. MethodsThirty consecutive patients underwent RA MIDCAB from May 2009 to February 2011. Most patients had single vessel disease in the left anterior descending (LAD) while others had multivessel disease amenable to MIDCAB to the LAD and PCI to other coronary arteries. Harvesting of the left internal mammary artery was performed without sternotomy using the daVinci Robot, followed by bypass of the LAD without cardiopulmonary bypass through a 5cm left thoracotomy incision. The cohort was stratified into high risk groups (first quartile by euroSCORE or STS score) and low risk groups (lowest third quartiles by euroSCORE or STS score). Operative parameters, postoperative complications, 30 day stroke and all-cause mortality were studied. Thirty consecutive patients underwent RA MIDCAB from May 2009 to February 2011. Most patients had single vessel disease in the left anterior descending (LAD) while others had multivessel disease amenable to MIDCAB to the LAD and PCI to other coronary arteries. Harvesting of the left internal mammary artery was performed without sternotomy using the daVinci Robot, followed by bypass of the LAD without cardiopulmonary bypass through a 5cm left thoracotomy incision. The cohort was stratified into high risk groups (first quartile by euroSCORE or STS score) and low risk groups (lowest third quartiles by euroSCORE or STS score). Operative parameters, postoperative complications, 30 day stroke and all-cause mortality were studied. ResultsThe median age of the entire cohort was 68 years old and 73% were male. There were no deaths or strokes at 30 days, however one low risk patient was converted to a sternotomy CABG. Using the euroSCORE, 10 patients were identified as high risk and 20 patients as low risk (6% vs. 2%, P < 0.0001). There was no difference in operative time (258 minutes vs. 242 minutes, P= 0.15), hospital length of stay (5.5 days vs. 4.5 days, P = 0.32) or postoperative complications between the high and low risk patients. When the cohort was stratified by STS score, 8 patients were identified as high risk and 22 patients as low risk (3.2% vs. 0.5%, P < 0.0001). Again, there was no difference in operative time (263 minutes vs. 249 minutes, P = 0.27), hospital length of stay (7 days vs. 4.5 days, P = 0.12) or postoperative complications. The median age of the entire cohort was 68 years old and 73% were male. There were no deaths or strokes at 30 days, however one low risk patient was converted to a sternotomy CABG. Using the euroSCORE, 10 patients were identified as high risk and 20 patients as low risk (6% vs. 2%, P < 0.0001). There was no difference in operative time (258 minutes vs. 242 minutes, P= 0.15), hospital length of stay (5.5 days vs. 4.5 days, P = 0.32) or postoperative complications between the high and low risk patients. When the cohort was stratified by STS score, 8 patients were identified as high risk and 22 patients as low risk (3.2% vs. 0.5%, P < 0.0001). Again, there was no difference in operative time (263 minutes vs. 249 minutes, P = 0.27), hospital length of stay (7 days vs. 4.5 days, P = 0.12) or postoperative complications. ConclusionRA MIDCAB provided the benefits of minimally invasive surgery to both high and low risk patients, with no deaths or strokes at 30 days and only a few minor postoperative complications. These results suggest that RA MIDCAB may be particularly beneficial for patients at high risk for standard CABG surgery or PCI, since they had comparable outcomes to low risk patients. RA MIDCAB provided the benefits of minimally invasive surgery to both high and low risk patients, with no deaths or strokes at 30 days and only a few minor postoperative complications. These results suggest that RA MIDCAB may be particularly beneficial for patients at high risk for standard CABG surgery or PCI, since they had comparable outcomes to low risk patients.