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Integrated revascularization treatment plans provide minimally invasive options for patients with multivessel coronary artery disease. This approach may be accomplished with no mortality, low perioperative morbidity, and excellent angiographic LIMA patency. The reintervention rate after PCI in this series was higher than that reported elsewhere and should be investigated further. The choice of suitable vessel, type of stent and timing of the treatment must be carefully considered before implementing this hybrid strategy.

Objectives: Institutional studies suggest robotic mitral surgery may be associated with superior outcomes. The objective of this study was to compare the outcomes of robotic, minimally invasive (mini), and conventional mitral surgery. Methods: A total of 2,351 patients undergoing non-emergent isolated mitral valve operations from 2011–2016 were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by approach: robotic(n=372), mini(n=576) and conventional sternotomy(n=1352). To account for preoperative differences, robotic cases were propensity score matched (1:1) to both conventional and mini approaches. Results Robotic cases were well matched to conventional (n=314) and mini (n=295) with no significant baseline differences. Rates of mitral repair were high in the robotic and mini cohorts (91%), but significantly lower with conventional (76%, p<0.0001) despite similar rates of degenerative disease. All procedural times were longest in the robotic cohort, including operative time (224 vs 168 minutes conventional, 222 vs 180 minutes mini; all p<0.0001). Robotic approach had comparable outcomes to conventional except fewer discharges to a facility (7% vs 15%, p=0.001) and 1 less day in the hospital (p<0.0001). However, compared to mini, robotic approach had higher transfusion (15% vs 5%, p<0.0001), atrial fibrillation rates (26% vs 18%, p=0.01) and 1 day longer average hospital stay (p=0.02). Conclusion: Despite longer procedural times, robotic and mini patients had similar complication rates with higher repair rates and shorter length of stay metrics compared to conventional surgery. However, robotic approach is associated with greater atrial fibrillation, transfusion and longer postoperative stays compared to minimally invasive approach.

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