Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery

Kuwabara, Hiroto; Nisivaco, Sarah; Balkhy, Husam H.

doi:10.1177/1556984519836896

Cited by 20 publications

(13 citation statements)

References 36 publications

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“…[ 53 – 55 ] It has been extensively demonstrated that robotic-assisted, endoscopic, multivessel CABG procedures are safe, feasible and reproducible and lead to excellent outcomes. [ 6 , 8 , 56 , 57 ]…”

Section: Techniques Of Minimally Invasive Coronary Artery Bypass Graftingmentioning

confidence: 99%

Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature

et al. 2021

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Minimally invasive coronary revascularisation was originally developed in the mid 1990s as minimally invasive direct coronary artery bypass (MIDCAB) grafting is a less invasive approach compared to conventional coronary artery bypass grafting (CABG) to address targets in the left anterior descending coronary artery (LAD). Since then, MIDCAB has evolved with the adoption of a robotic platform and the possibility to perform multivessel bypass procedures. Minimally invasive coronary revascularisation surgery also allows for a combination between the benefits of CABG and percutaneous coronary interventions for non-LAD lesions – a hybrid approach. Hybrid coronary revascularisation results in fewer blood transfusions, shorter hospital stay, decreased ventilation times and patients return to work sooner when compared to conventional CABG. This article reviews the available literature, describes standard approaches and considers topics, such as limited access procedures, indications and patient selection, diagnostics and imaging, techniques, anastomotic devices, hybrid coronary revascularisation and outcome analysis.

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Section: Techniques Of Minimally Invasive Coronary Artery Bypass Graftingmentioning

confidence: 99%

Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature

et al. 2021

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“…Previous reports have demonstrated that RA-MIDCAB is a safe and efficacious alternative to traditional CABG, providing favorable short-term outcomes and longterm graft patency (16,17). Additional advantages of the technique include reduced need for blood transfusion, shorter hospital stay, and improved quality of life (18).…”

Section: Ra-midcabmentioning

confidence: 99%

Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis

Eynde¹,

Bentein²,

Decaluwé³

et al. 2021

J Thorac Dis

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Learning curves are inevitably encountered when first implementing an innovative and complex surgical technique. Nevertheless, a cluster of failures or complications should be detected early, but not deter learning, to ensure safe implementation. Here, we aimed to examine the presence and impact of learning curves on outcome after robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB). Methods:A retrospective analysis of the first 300 RA-MIDCAB surgeries between July 2015 and December 2020 was performed. Learning curves were obtained via logarithmic regression for surgical time.Cumulative sum (CUSUM) analysis was performed for (I) major complications including MI, stroke, repeat revascularization, and mortality, and (II) other complications, including prolonged ventilation, pneumonia, pleura puncture, lung herniation, pericarditis, pleuritis, arrhythmia, wound complications, and delirium. Expected and unacceptable rates were set at 12% and 20%, respectively, for major complications, and at 40% and 60% for other complications, based on historical data in conventional coronary artery bypass grafting (CABG). Results: Demographic characteristics did not differ between terciles, except for more smokers in the first tercile, and less hypercholesterolemia and more complex procedures in the third tercile. The mean surgical time for all operations was 258±81 minutes, ranging from 127 to 821 minutes. A learning curve was only observed in the first tercile. Subgroup analysis revealed that this learning curve was only observed for procedures consisting of single internal mammary artery (SIMA) with 1 or 2 distal anastomoses but not with bilateral internal mammary arteries (BIMA) or more than 2 distal anastomoses. CUSUM analysis showed that the cumulative rate of major and other complications never crossed the lines for unacceptable rates. Rather, the lower 95% confidence boundary was crossed after 50 cases, indicating improvement in safety. Conclusions:These results suggest that integration of RA-MIDCAB in the surgical landscape can be safely achieved and complication rates can quickly be reduced below those expected in traditional CABG.Collective experience plays a key role in overcoming the learning curve when more complex procedures and cases are introduced.

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“…The conversion rate for TECAB has been trending down since the Göbölös publication 37 with many recent studies now suggesting rates <1%. 54 Reported operative times have also been decreasing with 20 to 30 cases to overcome the learning curve. 37 , 55 Cross-clamp time and CPB time of 67.9 min and 100.4 min, respectively, were reported in a meta-analysis by Leonard.…”

Section: Totally Endoscopic Coronary Artery Bypassmentioning

confidence: 99%

Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization

Hassanabad

Kang

Maitland

et al. 2021

Innovations�(Phila)

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Minimally invasive coronary revascularization techniques aim to avoid median sternotomy with its associated complications, while facilitating recovery and maintaining the benefits of surgical revascularization. The 3 most common procedures are minimally invasive coronary artery bypass grafting, totally endoscopic coronary artery bypass, and hybrid coronary revascularization. For a variety of reasons, including cost and technical difficulty, not many centers are routinely performing minimally invasive coronary revascularization. Nevertheless, many studies have assessed the safety and efficacy of each of these procedures in different clinical contexts. Thus far results have been promising, and with the evolution of procedural techniques, these approaches have the potential to redefine coronary revascularization in the future. This review highlights the current state of minimally invasive coronary revascularization techniques by exploring their benefits, identifying barriers to their adoption, and discussing future potential paradigms.

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Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery

Cited by 20 publications

References 36 publications

Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature

Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature

Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis

Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization

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