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Dokollari A, Gemelli M, Sicouri S, Gray WA, Shapiro TA, McGeehin F, Badri M, Coady P, Gnall E, Caroline M, Khan AA, Bonacchi M, Cabrucci F, Bacchi B, Chiarello B, Shah A, Spooner A, Ghorpade N, Hassanabad AF, Kjelstrom S, Montone G, Wertan MA, Ramlawi B, Sutter FP. Midterm Clinical Outcomes of Robotic-Assisted Reverse Hybrid Coronary Revascularization: A Single-Center Experience. Am J Cardiol 2024; 216:35-42. [PMID: 38185437 DOI: 10.1016/j.amjcard.2023.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/26/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
Outcomes of robotic-assisted reverse hybrid coronary revascularization (HCR) remain hindered. We aimed to analyze midterm clinical outcomes of robotic-assisted reverse HCR. All consecutive 285 patients who underwent reverse robotic-assisted HCR between September 2005 and July 2021 were included. Reverse HCR comprises percutaneous coronary intervention with stent implantation in non-left anterior descending (LAD) coronary arteries was performed within 30 days before robotic-assisted left internal thoracic artery (LITA) harvesting and LITA-to-LAD manual anastomosis through a 4-cm left minithoracotomy. Dual antiplatelet therapy was not interrupted in any patient. Preoperatively, mean age was 70.2 years (±11.2). Before surgery, 168 patients received 1 stent, 112 patients 2 stents, and 5 patients 3 stents. Intraoperatively, mean operating room time was 5.9 hours (±1); no case was converted to full sternotomy, whereas 9 patients (3.1%) received intraoperative blood product transfusions. Postoperatively, a small incidence of stroke, 1 (0.3%), reoperation for bleeding, 7 (2.4%), blood product transfusions, 48 (16.8%), and hospital stay (4.8 days) was observed. At 30-day follow-up, 1 patient (0.3%) underwent percutaneous coronary intervention with stent on a surgical LITA-LAD anastomosis owing to graft failure. Mean follow-up was 4.2 years. Reported midterm outcomes included all-cause death in 31 patients (10.9%), major adverse cardiovascular and cerebrovascular events in 102 of 285 (35.9%), nonfatal stroke in 2 of 285 (0.7%), myocardial infarction in 17 of 285 (5.9%), and repeat intervention in 50 of 285 patients (17.5%). This single-center study reports effective and safe clinical outcomes at midterm follow-up of reverse HCR procedures for treating multivessel coronary artery disease.
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Affiliation(s)
- Aleksander Dokollari
- Departments of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania; Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Marco Gemelli
- Cardiac Surgery Department, University of Padua, Padua, Italy
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
| | - William A Gray
- Interventional Cardiology, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Timothy A Shapiro
- Interventional Cardiology, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Frank McGeehin
- Interventional Cardiology, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Marwan Badri
- Interventional Cardiology, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Paul Coady
- Interventional Cardiology, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Eric Gnall
- Interventional Cardiology, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Mara Caroline
- Interventional Cardiology, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Amid A Khan
- Interventional Cardiology, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Massimo Bonacchi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesco Cabrucci
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Beatrice Bacchi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Bruno Chiarello
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Ashish Shah
- Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aaron Spooner
- Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nitin Ghorpade
- Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Fatehi Hassanabad
- Cardiac Surgery Department, Libin Cardiovascular Institute of Medicine, University of Alberta, Calgary, Alberta, Canada
| | - Stephanie Kjelstrom
- Population Health, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
| | - Georgia Montone
- Population Health, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
| | - Mary Ann Wertan
- Departments of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
| | - Basel Ramlawi
- Departments of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania; Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
| | - Francis P Sutter
- Departments of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania
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Imburgio S, Dandu S, Pannu V, Udongwo N, Johal A, Hossain M, Patel P, Sealove B, Almendral J, Heaton J. Sex-based differences in left ventricular assist device clinical outcomes. Catheter Cardiovasc Interv 2024; 103:376-381. [PMID: 37870108 DOI: 10.1002/ccd.30892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Heart failure (HF) continues to be a significant public health issue, posing a heightened risk of morbidity and mortality for both genders. Despite the widespread use of left ventricular assist device (LVAD), the influence of gender differences on clinical outcomes following implantation remains unclear. OBJECTIVES We investigated the impact of gender differences on readmission rates and other outcomes following LVAD implantation in patients admitted with advanced HF. METHODS We conducted a retrospective study of patients who underwent LVAD implantation for advanced HF between 2014 and 2020, using the Nationwide Readmissions Database. Our study cohort was divided into male and female patients. The primary outcome was 30-day readmission (30-dr), while secondary outcomes were inpatient mortality, length of stay (LOS), procedural complication rates, and periadmission rates. Multivariate linear, Cox, and logistic regression analyses were performed. RESULTS During the study period, 11,492 patients with advanced HF who had LVAD placement were identified. Of these, 22% (n = 2532) were females and 78% (n = 8960) were males. The mean age was 53.9 ± 10.8 years for females and 56.3 ± 10.5 years for males (adjusted Wald test, p < 0.01). Readmissions were higher in females (21% vs. 17%, p = 0.02) when compared to males. Cox regression analysis showed higher readmission events (hazard ratio: 1.24, 95% confidence interval: 1.01-1.52, p = 0.03) in females when compared to males. Inpatient mortality, LOS, and most procedural complication rates were not statistically significantly different between the two groups (p > 0.05, all). CONCLUSION Women experienced higher readmission rates and were more likely to be readmitted multiple times after LVAD implantation when compared to their male counterparts. However, there were no significant sex-based differences in inpatient mortality, LOS, and nearly all procedural complication rates. These findings suggest that female patients may require closer monitoring and targeted interventions to reduce readmission rates.
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Affiliation(s)
- Steven Imburgio
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Sowmya Dandu
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Viraaj Pannu
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Anmol Johal
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Palak Patel
- Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Brett Sealove
- Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Jesus Almendral
- Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Joseph Heaton
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
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Dokollari A, Sicouri S, Erten O, Gray WA, Shapiro TA, McGeehin F, Badri M, Coady P, Gnall E, Caroline M, Khan AA, Kjelstrom S, Montone G, Ramlawi B, Wertan MA, Sutter FP, Torregrossa G. Long-term clinical outcomes of robotic-assisted surgical coronary artery revascularisation. EUROINTERVENTION 2024; 20:45-55. [PMID: 37994042 PMCID: PMC10756223 DOI: 10.4244/eij-d-23-00373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/25/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Patients who are not candidates for traditional coronary artery bypass grafting (CABG) and amenable only for percutaneous coronary intervention (PCI) with stents can receive the "gold standard" left internal thoracic artery (LITA) to left anterior descending artery (LAD) anastomosis through robotic-assisted CABG and PCI to non-LAD coronary targets. AIMS We aimed to analyse clinical outcomes of robotic-assisted CABG. METHODS A total of 2,280 consecutive patients who had undergone robotic-assisted CABG between May 2005 and June 2021 were included in our study. Robotic-assisted LITA harvest was followed by LITA-LAD manual anastomosis through a 4 cm left thoracotomy. Hybrid coronary intervention (HCR) consists of stent implantation in a non-LAD coronary artery performed within 7 days after robotic-assisted LITA-LAD. We performed a propensity-adjusted analysis comparison after dividing all robotic-assisted CABG patients into three time periods: 2005-2010, 615 patients; 2011-2016, 904 patients; and 2017-2021, 761 patients. RESULTS The mean age increased from 64.5 years in the first time period to 65.8 years in the second time period to 68.1 years in the third (p<0.0001). Operative time was progressively reduced in the three periods (6.4; 6.2; 5.5 hours; p<0.001). The incidence of conversion to sternotomy remained similar for each period (1.8%; 1.7%; 1.5%; p=0.53). Thirty-day mortality in the three periods included 9 (1.4%), 9 (1.0%), and 7 (0.9%) patients, respectively (p=0.91), while 8 (0.3%) patients had PCI with stents in the entire group. The mean follow-up for the entire population was 4.2 years. At follow-up, the rates of all-cause death, major adverse cardiac and cerebrovascular events, non-fatal stroke, and repeat revascularisation with stents were significantly decreased from the first to the last period (pË0.0001). CONCLUSIONS Robotic-assisted CABG and HCR provide good long-term outcomes in patients who are not candidates for conventional CABG.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
| | - Ozgun Erten
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
| | - William A Gray
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Timothy A Shapiro
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Frank McGeehin
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Marwan Badri
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Paul Coady
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Eric Gnall
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Mara Caroline
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Amid A Khan
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Stephanie Kjelstrom
- Population Health, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
| | - Georgia Montone
- Population Health, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
| | - Mary Ann Wertan
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Francis P Sutter
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, USA
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