Minimally invasive surgery or stenting for left anterior descending artery disease – meta-analysis

Gianoli, Monica; Jong, Anne R de; Jacob, Kirolos A.; Namba, Hanae F; Kaaij, Niels P. van der; Harst, Pim van der; Suyker, Willem J.L.

doi:10.1016/j.ijcha.2022.101046

Cited by 7 publications

(11 citation statements)

References 54 publications

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“…Retrospective cohort studies and meta-analyses have reported all-cause mortality rates between 0% and 3% in patients undergoing HCR or MIDCAB, at 12 to 18 months of follow-up. 7,12 Our all-cause mortality rate of 2.5% at follow-up supports these prior findings. [13][14][15][16][17] We found a cardiac mortality rate of 1.6%, which is higher than what was found by others (0% to 1%) in cohort studies and randomized controlled trials.…”

Section: Discussionsupporting

confidence: 88%

“… 6 It is known that PCI has a higher repeat revascularization rate than CABG or MIDCAB. 6 , 7 Nevertheless, only 3 patients who underwent TVR initially underwent HCR. Our TVR rate is similar to prior reports.…”

Section: Discussionmentioning

confidence: 99%

“…This is confirmed by the meta-analysis that we performed in collaboration with our cardiologists. 7 In addition, when a patient also had a stenosis in the circumflex coronary artery or the right coronary artery, we considered HCR but also total arterial CABG. In our center, we routinely perform total arterial CABG in younger patients, but we are reluctant to treat low-grade stenosis (<80%) with an arterial graft due to the risk of inducing flow competition.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] We found a cardiac mortality rate of 1.6%, which is higher than what was found by others (0% to 1%) in cohort studies and randomized controlled trials. 7 However, of the 7 cases we classified as cardiac deaths, the cause of death was unknown for 4 patients. We can therefore not exclude other noncardiac causes of death, poor patient selection, or an unsuccessful rehabilitation after surgery in these cases.…”

Section: Discussionmentioning

confidence: 99%

“… 6 It has also been shown that, in comparison with PCI, RA-MIDCAB is associated with a reduced need for repeat revascularization and a survival benefit 3 years after the original procedure. 7 Despite these promising outcomes, criticism still persists as many cohort studies were hampered by small sample sizes and being single-center studies. 6 In this article, we report the clinical outcomes for all patients in the Netherlands who received RA-MIDCAB, to evaluate its benefits in a relatively large study population, also illustrating the benefits of a nationwide registry.…”

Section: Introductionmentioning

confidence: 99%

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A Nationwide Study of Clinical Outcomes After Robot-Assisted Coronary Artery Bypass Surgery and Hybrid Revascularization in the Netherlands

Jong

Gianoli

Namba

et al. 2023

Innovations�(Phila)

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Objective: Robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) surgery and hybrid coronary revascularization (HCR) are minimally invasive alternative strategies to conventional coronary artery bypass surgery in patients with isolated left anterior descending (LAD) stenosis or multivessel coronary disease. We analyzed a large, multicenter data-set based on the Netherlands Heart Registration including all patients undergoing RA-MIDCAB. Methods: We included 440 consecutive patients who underwent RA-MIDCAB with the left internal thoracic artery to LAD between January 2016 and December 2020. A proportion of patients underwent percutaneous coronary intervention (PCI) of non-LAD vessels (i.e., HCR). The primary outcome was all-cause mortality at median follow-up of 1 year, which was subdivided into cardiac and noncardiac. Secondary outcomes included target vessel revascularization (TVR) at median follow-up as well as 30-day mortality, perioperative myocardial infarction, reoperation for bleeding or anastomosis-related problems, and in-hospital ischemic cerebrovascular accident (iCVA). Results: Among all patients, 91 (21%) underwent HCR. At median (IQR) follow-up of 19 (8 to 28) months, 11 patients (2.5%) had died. In 7 patients, the cause of death was defined as cardiac. TVR occurred in 25 patients (5.7%), of whom 4 underwent CABG and 21 underwent PCI. At 30-day follow-up, 6 patients (1.4%) had a perioperative myocardial infarction, of whom 1 died. One patient (0.2%) developed an iCVA, and 18 patients (4.1%) underwent reoperation for bleeding or anastomosis-related problems. Conclusions: The clinical outcomes of patients undergoing RA-MIDCAB or HCR in the Netherlands are good and promising when compared with the currently available literature.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Nationwide Study of Clinical Outcomes After Robot-Assisted Coronary Artery Bypass Surgery and Hybrid Revascularization in the Netherlands

Jong

Gianoli

Namba

et al. 2023

Innovations�(Phila)

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2024 ESC Guidelines for the management of chronic coronary syndromes

Vrints,

Andreotti,

Koskinas

et al. 2024

European Heart Journal

120

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Cost Analysis of Robot-Assisted Versus On-Pump and Off-Pump Coronary Artery Bypass Grafting: A Single-Center Surgical and 30-Day Outcomes Comparison

Gianoli,

de Jong,

van der Harst

et al. 2024

Innovations�(Phila)

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Objective: Throughout Europe, the interest in implementing robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) has been growing. However, concerns about additional costs have emerged concurrently. In this analysis, we aim to provide a comparison of the cumulative perioperative costs of RA-MIDCAB, on-pump coronary artery bypass grafting (CABG), and off-pump CABG (OPCAB). Methods: We conducted a propensity score–matched analysis comparing patients undergoing RA-MIDCAB with those undergoing CABG or OPCAB at our institution from January 2016 to December 2021. After matching, we analyzed the combined intraoperative surgical costs and 30-day postoperative costs. We first compared RA-MIDCAB costs to CABG and then to OPCAB separately. Violin plots illustrated the cost distribution among individual patients. Total cost uncertainty was estimated using 1,000 bootstrapping iterations. Results: Seventy-nine RA-MIDCAB patients were matched to 158 CABG patients, and 80 RA-MIDCAB patients were matched to 149 OPCAB patients. Considering both surgical and clinical outcomes, RA-MIDCAB yielded an average cost of €17,121 per patient (€16,781 to €33,294), CABG was €16,571 per patient (€16,664 to €41,860), and OPCAB was €15,463 per patient (€10,895 to €57,867). After bootstrap iterations, RA-MIDCAB was found to be €472 (2.8%) and €1,599 (10.3%) more expensive per patient than CABG and OPCAB, respectively. Conclusions: In The Netherlands, the adoption of RA-MIDCAB did not show a significant economic impact on hospital resources. The additional robotic costs for the surgery were almost entirely offset by the cost savings during the postoperative hospital stay. However, these comparisons may differ when considering hybrid coronary revascularization with its additional percutaneous coronary intervention costs.

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Minimally invasive surgery or stenting for left anterior descending artery disease – meta-analysis

Cited by 7 publications

References 54 publications

A Nationwide Study of Clinical Outcomes After Robot-Assisted Coronary Artery Bypass Surgery and Hybrid Revascularization in the Netherlands

A Nationwide Study of Clinical Outcomes After Robot-Assisted Coronary Artery Bypass Surgery and Hybrid Revascularization in the Netherlands

2024 ESC Guidelines for the management of chronic coronary syndromes

Cost Analysis of Robot-Assisted Versus On-Pump and Off-Pump Coronary Artery Bypass Grafting: A Single-Center Surgical and 30-Day Outcomes Comparison

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