Clinical outcomes of multivessel coronary artery disease patients revascularized by robot-assisted vs conventional standard coronary artery bypass graft surgeries in real-world practice

Abstract

The treatment of patients with multivessel coronary artery disease (MVD) by coronary stenting (PCI) and the “gold standard” conventional coronary-artery bypass grafting (C-CABG) has been well explored in the literature. However, the clinical outcomes of robot-assisted CABG (R-CABG) vs C-CABG in MVD patients in real-world practice were unknown. We aimed to study the clinical outcomes of MVD patients who underwent R-CABG (robotic MIDCAB) and C-CABG at our institution between January 2005 and December 2013. A total of 516 MVD patients received CABG were recruited into this study. Among them, 281 patients received R-CABG and 235 patients underwent C-CABG. Patients in the R-CABG group were younger, and had fewer vessels with coronary artery disease (CAD), lower prevalence of chronic renal disease (CKD), higher left ventricular ejection fraction (LVEF), as well as lower Euro scores. The in-hospital and long-term mortalities were lower in the R-CABG group, but the incidences of target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), and stroke were not significantly different between the two groups. The long-term mortality was related to age, lower LVEF, and CKD, but not residual SYNTAX score, or completeness of revascularization. The revascularization modality (R-CABG vs C-CABG) was a borderline significantly independent predictor of long-term mortality (OR 1.76 [0.99–3.14], P = .055). Our study concluded that R-CABG, in comparison with C-CABG, for MVD carried out in younger patients involved fewer clinical complexities was associated with lower in-hospital and long-term mortalities in real-world practice. However, the long-term rates of TLR, TVR, MI, and stroke were similar. The long-term mortality was correlated with age, lower LVEF, and CKD, where R-CABG remained a borderline significant predictor after correcting for confounding factors. R-CABG could be an effective alternative to C-CABG for MVD patients with fewer clinical complexities in real-world practice.

Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques

“…RA-MIDCAB procedures have also been shown to have acceptable outcomes in patients with high SYNTAX scores. Lin and colleagues 42 reported lower in-hospital and long-term mortality following RA-MIDCAB compared with conventional CABG, with similar rates of target lesion or target vessel revascularization, myocardial infarction, and stroke. Long-term mortality was related to age, lower left ventricular ejection fraction, and chronic kidney disease, but not to the residual SYNTAX score, or completeness of revascularization.…”

Robotic-Assisted Solutions for Invasive Cardiology, Cardiac Surgery and Routine On-Ward Tasks: A Narrative Review

“…In 281 patients who received robot-assisted CABG and 235 patients undergoing traditional CABG, Lin et al looked at the long-term clinical results [ 46 ]. Following hospital release, the robotic-assisted CABG group and the traditional CABG group were followed for, respectively, 5.7 ± 3.0 and 5.0 ± 2.9 years on average, with statistical significance ( p < 0.001).…”

“…The risk of post-procedural complications including neurological events, rhythm disturbances, and need for re-intervention was low and similar for the two approaches. Therefore, robot-assisted ASD repair has comparable outcomes with the transcatheter approach, which additionally entails the risk of complications such as device embolization or malposition, chronic erosion, and migraine due to nickel allergy [ 44 , 45 , 46 ]. Of course, more experience is needed before conclusions are derived over the clinical, cost-effectiveness, and accessibility advantages of one method over the other.…”

Ninety-seven cases of experiences with the left thoracotomy approach for off-pump conventional revascularization: a retrospective cohort study

“…Therefore, procedures are being developed to minimize the invasiveness of the procedure and avoid complications while maintaining the proven advantages of surgical revascularization. Robot-assisted coronary bypass grafting ( 6 ), video-assisted coronary bypass grafting, minimally invasive multi-vessel CABG, and hybrid coronary revascularization are all well attempted; yet, some of these procedures may be more expensive.…”