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Zou F, Di Biase L. Editorial commentary: Robotic applications for intracardiac and endovascular procedures: Are we ready for robotic takeover? Trends Cardiovasc Med 2024; 34:118-119. [PMID: 36940839 DOI: 10.1016/j.tcm.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Fengwei Zou
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Luigi Di Biase
- Section Head Electrophysiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA.
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2
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Ding T, Yuan X, Chen K, Shen L, Guan C, Lv F, Xiong H, Xu B, Wu Y, Hu S. Simultaneous Hybrid Coronary Revascularization vs Conventional Strategies for Multivessel Coronary Artery Disease: A 10-Year Follow-Up. JACC Cardiovasc Interv 2023; 16:50-60. [PMID: 36599587 DOI: 10.1016/j.jcin.2022.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although evidence is sufficient to confirm that hybrid coronary revascularization (HCR) is safe and effective in the short term, its value in the long run is debatable. OBJECTIVES This study sought to compare the long-term outcomes of HCR with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multivessel disease. METHODS Three groups of patients, 540 each, receiving HCR, CABG, or PCI between June 2007 to September 2018, were matched using propensity score matching. Patients were stratified by EuroSCORE (European System for Cardiac Operative Risk Evaluation) II (low ≤0.9; 0.9 < medium <1.5; high ≥1.5) and SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (low ≤22; 22 < medium <33; high ≥33). Major adverse cardiac and cerebrovascular events (MACCE) and Seattle Angina Questionnaire (SAQ) scores were compared among the 3 groups. RESULTS In terms of MACCE and SAQ, HCR performed similarly to off-pump CABG but significantly outperformed PCI (P < 0.001). In the low-to-medium EuroSCORE II and medium-to-high SYNTAX score tertiles, MACCE rates in the HCR group were significantly lower than those in the PCI (EuroSCORE II: low, 30.7% vs 41.2%; P = 0.006; medium, 31.3% vs 41.7%; P = 0.013; SYNTAX score: medium, 27.6% vs 41.2%; P = 0.018; high, 32.4% vs 52.7%; P = 0.011) but were similar to those in the CABG group. In the high EuroSCORE II stratum, HCR had a lower MACCE rate than CABG (31.9% vs 47.0%; P = 0.041) and PCI (31.9% vs 53.7%; P = 0.015). CONCLUSIONS Compared with conventional strategies, HCR provided satisfactory long-term outcomes in MACCE and functional status for multivessel disease.
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Affiliation(s)
- Tong Ding
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kai Chen
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Liuzhong Shen
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Changdong Guan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Intervention, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Feng Lv
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hui Xiong
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Intervention, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yongjian Wu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shengshou Hu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Lehr EJ. Avoiding adverse outcomes while changing anastomotic technique in totally endoscopic robotic coronary artery bypass grafting. Ann Thorac Surg 2021; 114:482-483. [PMID: 34922912 DOI: 10.1016/j.athoracsur.2021.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, 1600 E Jefferson St, Ste 110, Seattle, WA 98122.
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Masroor S, Nasif A. The learning curve of robotic coronary arterial bypass surgery: A report from the STS database. J Card Surg 2021; 36:4187-4188. [PMID: 34459515 DOI: 10.1111/jocs.15944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Saqib Masroor
- Division of Cardiothoracic Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Abdullah Nasif
- Division of Cardiothoracic Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
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Patrick WL, Iyengar A, Han JJ, Mays JC, Helmers M, Kelly JJ, Wang X, Ghoreishi M, Taylor BS, Atluri P, Desai ND, Williams ML. The learning curve of robotic coronary arterial bypass surgery: A report from the STS database. J Card Surg 2021; 36:4178-4186. [PMID: 34459029 DOI: 10.1111/jocs.15945] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is limited data to inform minimum case requirements for training in robotically assisted coronary artery bypass grafting (RA-CABG). Current recommendations rely on nonclinical endpoints and expert opinion. OBJECTIVES To determine the minimum number of RA-CABG procedures required to achieve stable clinical outcomes. METHODS We included isolated RA-CABG in the Society of Thoracic Surgeons (STS) registry performed between 2014 and 2019 by surgeons without prior RA-CABG experience. Outcomes were approach conversion, reoperation, major morbidity or mortality, and procedural success. Case sequence number was used as a continuous variable in logistic regression with restricted cubic splines with fixed effects. Outcomes were compared between operations performed earlier versus later in case sequences using unadjusted and adjusted metrics. RESULTS There were 1195 cases performed by 114 surgeons. A visual inflection point occurs by a surgeon's 10th procedure for approach conversion, major morbidity or mortality, and overall procedural success after which outcomes stabilize. There was a significant decrease in the rate of approach conversion (7.7% and 2.5%), reoperation (18.9% and 10.8%), and major morbidity or mortality (21.7% and 12.9%), as well as an increase in the rate of procedural success (72.9% and 85.3%) with increasing experience between groups. In a multivariable logistic regression model, case sequences of >10 were an independent predictor of decreased approach conversion (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.09-0.84) and increased rate procedural success (OR: 1.96; 95% CI: 1.00-3.84). CONCLUSIONS The learning curve for RA-CABG is initially steep, but stable clinical outcomes are achieved after the 10th procedure.
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Affiliation(s)
- William L Patrick
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Philadelphia, Pennsylvania, USA
| | - Amit Iyengar
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason J Han
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jarvis C Mays
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Helmers
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John J Kelly
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xingmei Wang
- Biostatistics Analysis Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bradley S Taylor
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew L Williams
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Balkhy HH, Nisivaco S, Kitahara H, Torregrossa G, Patel B, Grady K, Coleman C. Robotic off-pump totally endoscopic coronary artery bypass in the current era: report of 544 patients. Eur J Cardiothorac Surg 2021; 61:439-446. [PMID: 34392341 DOI: 10.1093/ejcts/ezab378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/27/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Robotic off-pump totally endoscopic coronary artery bypass (TECAB) is the least invasive form of surgical coronary revascularization. It has proved to be highly effective and safe. Its benefits are well-established and include fewer complications, shorter hospital stay and quicker return to normal activities. TECAB has undergone 2 decades of technological advancement to include multivessel grafting, a beating-heart approach and successful completion in multiple patient groups in experienced hands. The aim of this report was to examine outcomes of robotic off-pump TECAB at our institution over 7 years. METHODS Data from 544 patients undergoing TECAB between July 2013 and August 2020 were retrospectively examined. The C-Port Flex-A distal anastomotic device was used for the majority of grafts (70%). Yearly follow-up was conducted. Angiographic early patency data were reviewed for patients undergoing hybrid revascularization. RESULTS The mean age was 66 years, with 1.7% mean STS risk. Fifty-six percentage had multivessel TECAB. There was 1 conversion to sternotomy, and 46% extubation in the Operating Room (OR). Mortality was 0.9%. Early graft patency was 97%. At mid-term follow-up at 38 months, cardiac mortality was 2.7% and freedom from major adverse cardiac events was 92.5%. CONCLUSIONS We conclude that robotic beating-heart TECAB in the current era is safe and effective with excellent outcomes and comparable early angiographic patency to standard coronary artery bypass grafting surgery when performed frequently by an experienced team. This procedure was completed in our hands both with and without an anastomotic device. Longer-term studies are warranted.
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Affiliation(s)
- Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Brooke Patel
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kaitlin Grady
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Charocka Coleman
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
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Yokoyama Y, Kuno T, Malik A, Briasoulis A. Outcomes of robotic coronary artery bypass versus nonrobotic coronary artery bypass. J Card Surg 2021; 36:3187-3192. [PMID: 34091953 DOI: 10.1111/jocs.15710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/19/2021] [Accepted: 05/17/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robotic coronary artery bypass graft (CABG) has developed in recent decades, however, prior studies showed conflicting result of robotic CABG compared to nonrobotic CABG in terms of mortality, morbidity, and cost. Herein, we sought to analyze the in-hospital outcomes and health care utilization after robotic CABG compared to nonrobotic CABG, based on data from a nationally representative sample. METHODS Patients who underwent CABG were identified using the national inpatient sample. Endpoints were in-hospital outcomes, length of stay, and total cost. Procedure-related complications were identified via international classification of diseases (ICD)-9 and ICD-10 coding and propensity score matching analysis was performed. RESULTS A total of 1,204,125 weighted adults underwent nonrobotic CABG and 7355 underwent robotic CABG in the United States between 2012 and 2017. The comparison of 7330 pairs after propensity score matching showed that in-hospital mortality was higher for those who underwent nonrobotic CABG compared to those who underwent robotic CABG (2.1% vs. 1.1%, p = .029). Similarly, the rates of acute kidney injury, transfusion, postoperative hemorrhage, length of stay, and total cost were higher for nonrobotic CABG compared to robotic CABG (all p < .05). The proportions of routine discharges with (34.5% vs. 40.0%) or without (39.7% vs. 45.0%) home health care were higher among those who underwent robotic, whereas the proportion of transfer to skilled nursing facility/nursing home was more frequent for cases of nonrobotic CABG (22.4% vs. 13.4%). CONCLUSION Robotic CABG was associated with lower rates of in-hospital mortality, acute kidney injury, transfusion, postoperative hemorrhage, total cost, and shorter hospital stay compared to nonrobotic CABG.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, New York, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Fatehi Hassanabad A, Kang J, Maitland A, Adams C, Kent WDT. Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:231-243. [PMID: 34081874 PMCID: PMC8217892 DOI: 10.1177/15569845211010767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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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Affiliation(s)
- Ali Fatehi Hassanabad
- 70401 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - Jimmy Kang
- 12357 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew Maitland
- 70401 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - Corey Adams
- 70401 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - William D T Kent
- 70401 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
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Cheng N, Zhang H, Yang M, Liu G, Guo Y, Kang W, Gao C, Wang R. Eleven-year outcomes of U-clips in totally robotic coronary artery bypass grafting versus standard hand-sewn running suture in robotic-assisted coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 33:27-33. [PMID: 33729469 DOI: 10.1093/icvts/ivab053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical outcomes of patients undergoing off-pump robotic coronary artery bypass grafting (CABG) with either interrupted nitinol U-Clips in totally endoscopic coronary artery bypass (TECAB) or standard running suture anastomosis in robotically assisted direct coronary artery bypass (RADCAB) over a decade. METHODS From January 2007 to December 2017, 280 patients underwent robotic off-pump CABG using the da Vinci S/Si Surgical System in our centre. TECAB with interrupted nitinol U-Clips anastomosis was performed in the left internal mammary artery (LIMA) to LAD grafting in 126 patients and RADCAB (n = 154) of the LIMA to LAD was completed with standard running suture. After discharge, patients were contacted through telephone interview and were invited to attend the outpatient clinic every 6 months or 1 year. The graft patency was assessed by coronary angiography or computed tomography angiography. RESULTS All cases were completed without conversion to median sternotomy or cardiopulmonary bypass. A total of 275 single internal mammary artery (IMA) grafts (271 LIMAs, 4 right internal mammary arteries) and 5 bilateral IMA grafts were used as single graft or composite grafts. All the patients were discharged without in-hospital mortality or adverse outcomes. The average follow-up was 89.7 ± 30.4 months (range, 14-143 months). The cumulative survival rates (P = 0.53), the cumulative IMA patency rates (P = 0.83), and the rates of freedom from major adverse cerebrovascular and cardiovascular events (P = 0.41) between TECAB and RADCAB all showed no significant difference in the follow-up. CONCLUSIONS Robotic off-pump CABG using IMA grafts is safe and can provide reliable long-term outcomes. Compared with the standard hand-sewn running suture technique in RADCAB, interrupted suture with the nitinol U-Clips in TECAB showed similar long-term clinical results and graft patency in LIMA to LAD bypass grafting.
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Affiliation(s)
- Nan Cheng
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Huajun Zhang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Ming Yang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Guopeng Liu
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Yi Guo
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Wenbin Kang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Changqing Gao
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Rong Wang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
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Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis 2021; 13:1922-1944. [PMID: 33841980 PMCID: PMC8024818 DOI: 10.21037/jtd-20-1535] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra- and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.
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Affiliation(s)
- Johannes Bonatti
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Stephanie Wallner
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Ingo Crailsheim
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Bernhard Winkler
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
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11
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Hammal F, Nagase F, Menon D, Ali I, Nagendran J, Stafinski T. Robot-assisted coronary artery bypass surgery: a systematic review and meta-analysis of comparative studies. Can J Surg 2020. [PMID: 33155975 DOI: 10.1503/cjs.013318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Robot-assisted coronary bypass (RCAB) surgery has been proposed as an alternative to conventional coronary artery bypass grafting (C-CABG) for managing coronary heart disease, but the evidence on its performance compared to other existing treatments is unclear. The aim of this study was to assess, through a systematic review of comparative studies, the safety and clinical effectiveness of RCAB compared to C-CABG and other minimally invasive approaches for the treatment of coronary heart disease. METHODS We conducted a systematic review of primary studies in the English-language literature comparing RCAB to existing treatment options (C-CABG, minimally invasive direct coronary artery bypass [MIDCAB] and port-access coronary artery bypass [PA-CAB]) following Cochrane Collaboration guidelines. Meta-analyses were performed where appropriate. RESULTS We reviewed 13 studies: 11 primary studies of RCAB (v. C-CABG in 7, v. MIDCAB in 3 and v. PA-CAB in 1) and 2 multicentre database studies (RCAB v. non-RCAB). The overall quality of the evidence was low. Most studies showed no significant benefit of RCAB over other treatments in a majority of outcome variables. Meta-analyses showed that RCAB had lower rates of pneumonia or wound infection than C-CABG, and shorter intensive care unit length of stay than C-CABG or MIDCAB. Individual studies showed that RCAB had some better outcomes than C-CABG (ventilation time, transfusion, postoperative pain, hospital length of stay) or MIDCAB (transfusion, postoperative pain, time to return to normal activities, physical functioning and hospital length of stay). The review of the database studies showed that RCAB was statistically superior to non-RCAB approaches in postoperative pain, renal failure, transfusion, reoperation for bleeding, stroke and hospital length of stay; however, the difference between the 2 groups in several of these outcomes was small. CONCLUSION Although the findings from this review of comparative studies of RCAB appear promising and suggest that RCAB may offer some benefits to patients, in the absence of randomized controlled trials, these results should be interpreted cautiously.
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Affiliation(s)
- Fadi Hammal
- From the Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB (Ali); and the Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB (Nagendran)
| | - Fernanda Nagase
- From the Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB (Ali); and the Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB (Nagendran)
| | - Devidas Menon
- From the Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB (Ali); and the Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB (Nagendran)
| | - Imtiaz Ali
- From the Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB (Ali); and the Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB (Nagendran)
| | - Jeevan Nagendran
- From the Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB (Ali); and the Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB (Nagendran)
| | - Tania Stafinski
- From the Health Technology & Policy Unit, School of Public Health, University of Alberta, Edmonton, AB (Hammal, Nagase, Menon, Stafinski); the Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB (Ali); and the Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta HeartInstitute, University of Alberta, Edmonton, AB (Nagendran)
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Fiorilli PN. Editorial commentary: Minimally invasive & hybrid revascularization strategies - where do they fit? Trends Cardiovasc Med 2020; 31:392-393. [PMID: 32947008 DOI: 10.1016/j.tcm.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Paul N Fiorilli
- Cardiovascular Medicine Division, 11th floor South Pavilion, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States; Cardiovascular Outcomes, Quality, & Evaluative Research Center, Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
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Sotolongo A, Geirsson A. Commentary: Coronary revascularization: How should we do it? JTCVS Tech 2020; 3:173. [PMID: 34317859 PMCID: PMC8303066 DOI: 10.1016/j.xjtc.2020.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alex Sotolongo
- Section of Cardiac Surgery, Department of Surgery, Yale-New Haven Health, New Haven, Conn
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale-New Haven Health, New Haven, Conn
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Moreno PR, Stone GW, Gonzalez-Lengua CA, Puskas JD. The Hybrid Coronary Approach for Optimal Revascularization. J Am Coll Cardiol 2020; 76:321-333. [DOI: 10.1016/j.jacc.2020.04.078] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
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The Future of Open Heart Surgery in the Era of Robotic and Minimal Surgical Interventions. Heart Lung Circ 2020; 29:49-61. [DOI: 10.1016/j.hlc.2019.05.170] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/17/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
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Kitahara H, Nisivaco S, Balkhy HH. Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:117-123. [DOI: 10.1177/1556984519836896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective With advances in robotic instrumentation and technology, both robotically assisted minimally invasive direct coronary artery bypass (RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been widely used over the past 20 years. Graft patency is the most important outcome in coronary bypass surgery and is associated with long-term prognosis. In this article we reviewed all experts’ studies in the field of robotic assisted coronary artery bypass and investigated graft patency in patients who underwent RMIDCAB or TECAB. Methods We performed a literature search in PubMed from 1999 to 2018 using the terms “Robotic” and “Coronary bypass” and/or “Minimally invasive” and/or “Totally endoscopic.” Of the articles found, studies investigating graft patency were specifically selected. Results In 33 articles, a total of 4,000 patients underwent robotic assisted coronary artery bypass surgery either by a RMIDCAB (2,396) or by a TECAB (1,604) approach. The graft patency was assessed by invasive angiography or computed tomographic angiography in all studies. The mean graft patency at early (<1 month), midterm (<5 years), and long-term (>5 years) follow-up was 97.7%, 96.1%, and 93.2% in RMIDCAB and 98.8%, 95.8%, and 93.6% in TECAB, respectively. Conclusions The graft patency of robotic assisted coronary artery bypass was equivalent to reported outcomes of the conventional approach. These results should encourage the adoption of robotic approaches in coronary bypass surgery.
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Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Systematic Review of Clinical Outcomes from the Past two Decades. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:5-16. [DOI: 10.1177/1556984519827703] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Robotic totally endoscopic coronary artery bypass grafting (TECAB) was introduced in 1998 and has over a period of two decades gradually emerged from single-vessel revascularization to multivessel bypass grafting. Dedicated centers have continuously evolved and further developed this minimally invasive method of coronary bypass surgery. A literature review was conducted to assess intra- and postoperative outcomes of TECAB. PubMed returned 19 comprehensive articles on TECAB. Investigation was focused on perioperative outcome parameters, i.e.: operative time, conversion to larger incision, revision for bleeding, atrial fibrillation, stroke, acute renal failure, and mortality. Outcome from the analysis of 2,397 reported cases showed an average operative time of 291 ± 57 minutes (range 112 to 1,050), conversion rate to larger incisions at 11.5%, and perioperative mortality at 0.8%. Pooled data demonstrated 4.2% operative revision rate due to postoperative hemorrhage, 1.0% stroke incidence, 1.6% acute renal failure, and 13.3% de novo atrial fibrillation. The mean length of hospital stay measured 5.8 ± 1.7 days. Conversion rates and operative times decreased over time. According to data in the literature, coronary bypass surgery carried out in completely endoscopic fashion utilizing robotic assistance can require relatively extensive operative times and conversion rates are somewhat higher than in other robotic cardiac surgery. However, major postoperative events lie in an acceptable range. TECAB remains the surgical revascularization method with the least tissue trauma and represents an opportunity for coronary artery bypass grafting via port access. Rates of major complications are at least similar to conventional surgical access procedures.
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Watkins AC, Ghoreishi M, Maassel NL, Wehman B, Demirci F, Griffith BP, Gammie JS, Taylor BS. Programmatic and Surgeon Specialization Improves Mortality in Isolated Coronary Bypass Grafting. Ann Thorac Surg 2018; 106:1150-1158. [PMID: 30056995 DOI: 10.1016/j.athoracsur.2018.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/09/2018] [Accepted: 05/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Throughout surgery, specialization in a procedure has been shown to improve outcomes. Currently, there is no evidence for or against subspecialization in coronary surgery. Tasked with the goal of improving outcomes after isolated coronary artery bypass grafting (CABG), our institution sought to determine whether the development of a subspecialized coronary surgery program would improve morbidity and mortality. METHODS All isolated CABG operations at a single institution were retrospectively examined in two distinct periods, 2002 to 2013 and 2013 to 2016, before and after the implementation of a subspecialized coronary surgery program. Improved policies included leadership and subspecialization of a program director, standardization of surgical technique and postoperative care, and monthly multidisciplinary quality review. Outcomes were collected and compared. RESULTS Between 2002 and 2013, 3,256 CABG operations were done by 16 surgeons, the most frequent surgeon doing 33%. Between 2013 and 2016, 1,283 operations were done by 10 surgeons, 70% by the coronary program director. CABGs done in the specialized era had shorter bypass and clamps times and increased use of bilateral internal mammary arteries. Blood transfusion and complication rates, including permanent stroke and prolonged ventilation, were significantly decreased after implementation of the coronary program. Likewise, overall operative mortality (2.67% vs 1.48%, p = 0.02) was significantly reduced. CONCLUSIONS Subspecialization in CABG and dedicated coronary surgery programs may lead to faster operations, increased use of bilateral internal mammary arteries, fewer complications, and improved survival after isolated CABG.
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Affiliation(s)
- A Claire Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan L Maassel
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Brody Wehman
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Filiz Demirci
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bradley S Taylor
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Totally endoscopic coronary artery bypass surgery: A meta-analysis of the current evidence. Int J Cardiol 2018; 261:42-46. [DOI: 10.1016/j.ijcard.2017.12.071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022]
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Cao C, Indraratna P, Doyle M, Tian DH, Liou K, Munkholm-Larsen S, Uys C, Virk S. A systematic review on robotic coronary artery bypass graft surgery. Ann Cardiothorac Surg 2016; 5:530-543. [PMID: 27942485 DOI: 10.21037/acs.2016.11.08] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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 off-pump); (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 follow-up 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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Affiliation(s)
- Christopher Cao
- The Collaborative Research (CORE) group, Macquarie University, Sydney, Australia;; Department of Cardiothoracic Surgery, St. George Hospital, Sydney, Australia
| | - Praveen Indraratna
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia;; University of New South Wales, Sydney, Australia
| | - Mathew Doyle
- Department of Cardiothoracic Surgery, St. George Hospital, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) group, Macquarie University, Sydney, Australia;; Royal North Shore Hospital, Sydney, Australia
| | - Kevin Liou
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | | | - Ciska Uys
- Department of Cardiothoracic Surgery, St. George Hospital, Sydney, Australia
| | - Sohaib Virk
- The Collaborative Research (CORE) group, Macquarie University, Sydney, Australia
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Yang M, Wu Y, Wang G, Xiao C, Zhang H, Gao C. Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency. Ann Thorac Surg 2015; 100:1367-73. [DOI: 10.1016/j.athoracsur.2015.04.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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