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Varrone M, Sarmiento IC, Pirelli L, Brinster DR, Singh VP, Kim MC, Scheinerman SJ, Patel NC, Hemli JM. Minimally Invasive Direct Coronary Artery Bypass: An Evolving Paradigm Over the Past 25 Years. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:521-527. [PMID: 36424729 DOI: 10.1177/15569845221137616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We have routinely utilized minimally invasive direct coronary artery bypass (MIDCAB) for revascularization of the left anterior descending (LAD) coronary artery. We examined how this procedure has evolved. METHODS A retrospective review was undertaken of 2,283 consecutive patients who underwent MIDCAB between 1997 and 2021. Patients were divided into 3 groups: group A from 1997 to 2002 (n = 751, 32.9%), group B from 2003 to 2009 (n = 452, 19.8%), and group C from 2009 to 2021 (n = 1,080, 47.3%). Risk profiles and short-term outcomes were analyzed for the entire cohort and for 293 propensity-matched patients drawn from each group. RESULTS The left internal mammary artery was harvested open in group A but with robotic assistance in group C. Thirty-day mortality was higher in group A versus group C (12 deaths, 1.6% vs 5 deaths, 0.5%, P = 0.044); this difference was negated after propensity matching. Group A had more comorbidities than group C, including peripheral vascular disease (17.7% vs 10.0%, P < 0.001), congestive heart failure (39.6% vs 18.0%, P < 0.001), and a history of stroke (17.9% vs 10.0%, P < 0.001), although diabetes mellitus was more common in group C (51.4% vs 31.0%, P < 0.001). Stroke was greater in group A (1.2% vs 0.0% vs 0.2%, respectively, P = 0.004), as was the need for prolonged ventilation (3.6% vs 0.2% vs 0.9%, respectively, P < 0.001), before and after propensity matching. CONCLUSIONS MIDCAB patients had less comorbidities than in the past. Robot-assisted MIDCAB was associated with lower stroke risk.
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Affiliation(s)
- Michael Varrone
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Iam Claire Sarmiento
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Luigi Pirelli
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Derek R Brinster
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Varinder P Singh
- Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Michael C Kim
- Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - S Jacob Scheinerman
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Nirav C Patel
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Jonathan M Hemli
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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Amabile A, Torregrossa G, Balkhy HH. Robotic-assisted coronary artery bypass grafting: current knowledge and future perspectives. Minerva Cardioangiol 2021; 68:497-510. [PMID: 33155785 DOI: 10.23736/s0026-4725.20.05302-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minimally invasive direct coronary artery bypass grafting (MIDCAB) and totally endoscopic coronary artery bypass grafting (TECAB) are the two existing strategies for robotic-assisted, surgical myocardial revascularization. In this review, we summarize the wide evidence available in the literature regarding the benefits of these two procedures, and detail the technical skills required to master robotic coronary surgery techniques.
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Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA -
| | - Gianluca Torregrossa
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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Gorki H, Patel NC, Balacumaraswami L, Jennings J, Goksedef D, Subramanian VA. Long-Term Survival after Minimal Invasive Direct Coronary Artery Bypass (MIDCAB) Surgery in Patients with Low Ejection Fraction. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:400-6. [DOI: 10.1177/155698451000500604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The long-term survival after minimal invasive direct coronary artery bypass (MIDCAB) surgery to any coronary territory in patients with ejection fraction of ≤30% was investigated for the first time in literature. Methods Seventy-three patients with primary MIDCAB and 89 patients with reoperative MIDCAB were studied including preoperative risk factors, operative details, early postoperative complications, and survival up to 10 years postoperatively. Results Despite the high-risk profile of the patients, the MIDCAB approach for targeted revascularization resulted in excellent short-term results. Ventricular arrhythmia contributed to four of six early deaths. Survival at 5 years postoperatively was 62.5% for primary MIDCAB and 43.2% for reoperative MIDCAB and at 10 years was 36.9% and 29.5%, respectively. Functionally complete vascularization correlates with significantly better long-term survival particularly in primary MIDCAB procedures. Conclusions MIDCAB is a valuable option for targeted revascularization in high-risk patients with low ejection fraction and reoperation.
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Affiliation(s)
- Hagen Gorki
- Department of Cardiothoracic Surgery, Lenox Hill Hospital New York, New York, NY USA
| | - Nirav C. Patel
- Department of Cardiothoracic Surgery, Lenox Hill Hospital New York, New York, NY USA
| | | | - Joan Jennings
- Department of Cardiothoracic Surgery, Lenox Hill Hospital New York, New York, NY USA
| | - Deniz Goksedef
- Department of Cardiothoracic Surgery, Lenox Hill Hospital New York, New York, NY USA
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