Robotic hybrid coronary revascularization versus conventional off‐pump coronary bypass surgery in women with two‐vessel disease

Torregrossa, Gianluca; Sá, Michel Pompeu Barros de Oliveira; Eynde, Jef Van den; Sicouri, Serge; Wertan, MaryAnn C.; Ramlawi, Basel; Sutter, Francis P.

doi:10.1111/jocs.16146

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…In our experience, robotic CABG, in selected patients, was superior to off-pump CABG with sternotomy in the immediate postoperative period and had similar outcomes on the long-term (71). Given our findings from this review, several surgeons and programs may benefit from robotic CABG.…”

Section: Discussionmentioning

confidence: 67%

“…It is recommended that trainees develop essential instrumental skills including a robust method of instrument position and use. Two clinical studies (70,71) have proven that intensive and console training in performing incision and knot tie reduces the time of the procedure as well as the number of errors. Console instrumental skills need to be developed in a mentored situational environment, first in a drylab and further in a wetlab.…”

Section: Future Perspectivesmentioning

confidence: 99%

See 1 more Smart Citation

Establishing a robotic coronary artery bypass surgery program: a narrative review

Torregrossa¹,

Dokollari²,

Sá³

et al. 2023

J Vis Surg

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Background and Objective: Robotic coronary artery bypass surgery is an established procedure for treatment of coronary artery disease. The goal of this manuscript is to provide an overview on how to build a successful robotic coronary artery bypass grafting (CABG) surgery program and analyze its learning curve.Methods: We performed a narrative review of the current medical literature comparing the robotic CABG survival rate. English literature published by January 30 th , 2021 were searched in PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL and Google Scholar.

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Section: Discussionmentioning

confidence: 67%

Section: Future Perspectivesmentioning

confidence: 99%

Establishing a robotic coronary artery bypass surgery program: a narrative review

Torregrossa¹,

Dokollari²,

Sá³

et al. 2023

J Vis Surg

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“…Furthermore, contrarily to the widespread belief, hybrid procedures with stents did not yield worse results over time in comparison with the nonhybrid group (likely owing to the evolution of drug‐eluting stents). We demonstrated in previous studies that patients treated surgically for coronary disease can be equally treated with LIMA to LAD plus saphenous vein grafts or stents for non‐LAD vessels with similar long‐term outcomes, 27–29 suggesting that contemporary stents can be as effective as other grafts to treat non‐LAD lesions. There is an interesting aspect in our study which we should highlight.…”

Section: Discussionmentioning

confidence: 80%

Robotic‐assisted versus conventional off‐pump coronary surgery in women: A propensity‐matched study

Torregrossa

Sá

Eynde

et al. 2022

Journal of Cardiac Surgery

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Background: Off-pump coronary artery bypass (OPCAB) previously demonstrated its potential benefits in women; however, robotic-assisted OPCAB was scarcely studied.Objectives: To investigate whether robotic-assisted OPCAB could further improve the outcomes in women and the potential impact of hybrid approaches with stents and completeness of revascularization on the late outcomes. Methods: Women who underwent robotic-assisted or conventional OPCAB (with sternotomy) between May 2005 and January 2021 at Lankenau Heart Institute were included. Propensity score matching was used to match 273 pairs on 27 characteristics.Results: In the intraoperative period, women who underwent robotic-assisted OPCAB presented longer operative times (6.00 vs. 5.38 h; p < 0.001), higher rates of extubation in the operating room (83.9% vs. 75.5%; p = 0.019) and lower rates of blood transfusion (13.2% vs. 32.2%; p < 0.001). In the postoperative period, women who underwent robotic-assisted OPCAB presented lower rates of new onset atrial fibrillation (16.8% vs. 25.6%; p = 0.016), need of blood transfusion (33.0% vs. 54.9%; p < 0.001), shorter intensive care unit (ICU) (46.1 vs. 49.8 h; p = 0.006) and hospital length of stay (5.0 vs. 6.0 days; p < 0.001). We observed no statistically significant differences in the rates of operative death between the groups (1.47% vs. 1.47%; p = 0.771). In the follow-up, we observed no differences in terms of overall survival regardless of hybrid procedures with stents and completeness of revascularization.Conclusions: Robotic-assisted OPCAB in women is as safe as conventional OPCAB and may further improve outcomes. Hybrid coronary revascularization was a valuable adjunct in the robotic scenario and completeness of revascularization did not play a role in this setting.

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“…Minimally invasive multivessel coronary artery bypass grafting (CABG) is gaining more acceptance in the cardiac surgical society (1,2). Main minimally invasive CABG approaches had a list of disadvantages starting from surgery technique complicity, duration of procedures, expensive equipment requiring, long learning curve and patient selection (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Multivessel minimally invasive on-pump direct coronary artery revascularization

Babliak¹,

Demianenko²,

Marchenko³

et al. 2023

J Vis Surg

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Background: Our aim was to describe the technique of minimally invasive on-pump multivessel coronary revascularization through the left anterior thoracotomy, evaluate the intraoperative and early postoperative results.Methods: In this single-center retrospective cohort study we investigated the outcomes of 521 consecutive patients with isolated multivessel coronary artery disease (CAD) who were operated from July 2017 to December 2021. All operations performed via the left anterior minithoracotomy through the fourth intercostal space. Transthoracic clamp and blood cardioplegia were used for heart arrest and special maneuvers for coronary exposition. This technique was named total coronary revascularization via left anterior thoracotomy (TCRAT). Results:The mean number of grafts was 2.97±0.7 [range, 2-5]. Left internal mammary artery (LIMA) was used in 494 (94.8%) patients, the right internal mammary artery (RIMA) in 10 (1.9%) patients, radial artery in 153 (29.4%) patients, and veins in 429 (82.3%) patients. In our series the mortality rate was 0.57% (3 cases), 2 (0.38%) conversions to sternotomy due to acute aortic dissection and no postoperative myocardial infarctions were observed. There were 2 (0.38%) postoperative strokes and 6 (1.15%) revisions for postoperative bleeding without conversion to sternotomy. The total operation time was 269±51.8 minutes, cardiopulmonary bypass time 145.7±33.5 minutes, and aortic cross-clamp time 71.9±19.9 minutes. The mean intensive care stay was 2.1±1.2 days and mean total hospital stay 5.9±2.2 days Conclusions: The TCRAT technique could be used as a routine method of coronary artery bypass grafting (CABG) and provide the possibility to fully eliminate sternotomy for almost all patients (except porcelain aorta) with isolated multivessel CAD. Special surgical maneuvers for coronary targets exposure have made TCRAT more universal in practice than other minimally invasive CABG techniques. This technique preserves principles of complete coronary revascularisation and is applicable for multivessel CABG with use of standard coronary instruments and anastomotic techniques.

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Robotic hybrid coronary revascularization versus conventional off‐pump coronary bypass surgery in women with two‐vessel disease

Cited by 8 publications

References 21 publications

Establishing a robotic coronary artery bypass surgery program: a narrative review

Establishing a robotic coronary artery bypass surgery program: a narrative review

Robotic‐assisted versus conventional off‐pump coronary surgery in women: A propensity‐matched study

Multivessel minimally invasive on-pump direct coronary artery revascularization

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