In-Hospital Mortality and Morbidity After Robotic Coronary Artery Surgery

Cavallaro, Paul; Rhee, Amanda J.; Chiang, Yu-Ting; Itagaki, Shinobu; Seigerman, Matthew; Chikwe, Joanna

doi:10.1053/j.jvca.2014.03.009

Cited by 22 publications

(36 citation statements)

References 16 publications

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“…The conversion and severe postoperative complication rate was lower in this study than reported elsewhere [8,9,18,20,21]. No death or conversion to median sternotomy occurred in either both the TECAB or MINICAB groups, and postoperative bleeding occurred in 1% of the TECAB group during the learning curve.…”

Section: Commentcontrasting

confidence: 58%

“…Recent long-term follow-up studies [8,9] showed an equivalent result in terms of mortality, major adverse cardiovascular events, and need for revascularization between robotic and conventional CABG. More encouragingly, robotic CABG is likely to reduce postoperative complications in patients with single-vessel disease [18]. Although the early clinical results of robotic CABG were excellent with acceptable graft patency [19], the longer term graft patency and the freedom from mortality and morbidity were still unclear.…”

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency

Yang

Wang

et al. 2015

The Annals of Thoracic Surgery

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Section: Commentcontrasting

confidence: 58%

Section: Commentmentioning

confidence: 99%

Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency

Yang

Wang

et al. 2015

The Annals of Thoracic Surgery

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“…One study provided separate data for both the TECAB offpump and robotic MIDCAB groups, and was included for analysis in both groups (10). Eighteen additional studies reported on a mixture of different surgical techniques (18,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53). A summary of the study selection process is presented in the PRISMA chart in Figure 1, and a summary of study characteristics is presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-one studies were excluded from the final analysis due to a mixed dataset for different surgical techniques (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) or use of cardiopulmonary bypass (36)(37)(38)(39)(40)(41), or use of an outdated robotic system other than the da Vinci system (18,34,35). Of the patients who were included for statistical analysis in the selected studies on off-pump TECAB, on-pump TECAB and robotic MIDCAB, the mean age ranged from 58 to 67, and 51-88% of patients were male.…”

Section: Resultsmentioning

confidence: 99%

A systematic review on robotic coronary artery bypass graft surgery

Cao

Indraratna

Doyle

et al. 2016

Ann. Cardiothorac. Surg.

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Background: Robotic-assisted coronary artery bypass graft surgery (CABG) has been performed over the past decade. Despite encouraging results from selected centres, there is a paucity of robust clinical data to establish its clinical safety and efficacy. The present systematic review aimed to identify all relevant clinical data on robotic CABG. The primary endpoint was perioperative mortality, and secondary endpoints included perioperative morbidities, anastomotic complications, and long-term survival.Methods: Electronic searches were performed using three online databases from their dates of inception to 2016. Relevant studies fulfilling the predefined search criteria were categorized according to surgical techniques as (I) totally endoscopic coronary artery bypass without cardiopulmonary bypass (TECAB offpump); (II) TECAB on-pump; and robotic-assisted mammary artery harvesting followed by minimally invasive direct coronary artery bypass (robotic MIDCAB).Results: The present systematic review identified 44 studies that fulfilled the study selection criteria, including nine studies in the TECAB off-pump group and 16 studies in the robotic MIDCAB group.Statistical analysis reported a pooled mortality of 1.7% for the TECAB off-pump group and 1.0% for the robotic MIDCAB group. Intraoperative details such as the number and location of grafts performed, operative times and conversion rates, as well as postoperative secondary endpoints such as morbidities, anastomotic complications and long-term outcomes were also summarized for both techniques.Conclusions: A number of technical, logistic and cost-related issues continue to hinder the popularization of the robotic CABG procedure. Current clinical evidence is limited by a lack of randomized controlled trials, heterogeneous definition of techniques and complications, as well as a lack of robust clinical followup with routine angiography. Nonetheless, the present systematic review reported acceptable perioperative mortality rates for selected patients at specialized centres. These results should be considered as a useful benchmark for future studies, until further data is reported in the form of randomized trials.

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“…Similar to PCI, a robotic operation enables coronary artery disease to be treated less invasively via small incisions in between the ribs that spare the sternal bone. R-CABG has been shown to reduce invasiveness and postoperative complications compared to the open chest option (Cavallaro, Rhee et al 2015, Whellan, McCarey et al 2016). In contrast to PCI and CABG via sternotomy, rCABG is technically complex and has not been widely adopted outside of a few expert centers.…”

Section: Introductionmentioning

confidence: 99%

Direct to consumer advertising of robotic heart bypass surgery

Kiani

Kurian

Henkin

et al. 2016

IJPHM

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Purpose Robotic coronary artery bypass (rCABG) is a relatively novel and less invasive form of surgery. A yearlong direct-to-consumer advertising (DTCA) campaign was initiated to provide the community with information regarding rCABG, increase awareness and recruit patients. To optimize information content and ensure appropriate messaging for future campaigns, this study aims to analyze the campaign effectiveness and compared service quality perceptions and clinical outcomes, following surgery across DTCA-responder and control groups. Design/methodology/approach The institution initiated an rCABG program and one-year DTCA campaign. The authors prospectively documented all rCABG referrals prompted by these ads (DTCA-responder group) and concurrent referrals from medical providers (controls). Groups were compared according to baseline characteristics, perioperative outcomes, patient satisfaction (HCAHPS survey) and functional capacity at three weeks (Duke Activity Status Index). At six months, both groups were surveyed for patient satisfaction and unmet expectations. Findings There were 103 DTCA responders and 77 controls. The subset of responders that underwent rCABG (n = 54) had similar characteristics to controls, except they were younger, less likely to have lung disease or to be scheduled as an urgent case. Both groups had similar 30-day clinical outcomes, functional capacity recovery and overall satisfaction at three weeks. Follow-up interviews at six months and four years revealed that the DTCA group reported more unmet expectations regarding the “size of the skin incisions” and “recovery time” but no concern about “expertise of their surgeon”. Practical implications The DTCA campaign was effective at recruiting patients. The specific focus of the ads and narrow timeframe for decision-making about CABG lends confidence that the incremental cases seen during the campaign were prompted primarily by DTCA. However, differences in unmet expectations underscore the need to better understand the impact of message content on patients recruited via DTCA campaigns. Originality/value This is one of the first studies to provide real-world direct empirical evidence of patients’ clinical and attitudinal outcomes for DTCA campaigns. Furthermore, the findings contradict prevailing beliefs that DTCA is ineffective for prompting surgical referrals.

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In-Hospital Mortality and Morbidity After Robotic Coronary Artery Surgery

Cited by 22 publications

References 16 publications

Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency

Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency

A systematic review on robotic coronary artery bypass graft surgery

Direct to consumer advertising of robotic heart bypass surgery

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