Robot-assisted minimally invasive coronary artery bypass in treating multi-vessel coronary artery disease: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Yuqian ¹ , ZHANG Liyue ¹ , CHENG Nan ² , DONG Shiyong ² , SHEN Hua ² ,  WANG Rong ²

1. Medical School of Chinese PLA, 100853, Beijing, P. R. China;
2. Department of Adult Cardiovascular Surgery, Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 100048, Beijing, P. R. China;

Corresponding author：

WANG Rong, Email: wangrongd@126.com

Keywords：

Coronary artery disease; multi-vessel disease; robot-assisted surgery; coronary artery bypass grafting; hybrid coronary revascularization

DOI：

10.7507/1007-4848.202210041

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Objective To evaluate the early and mid-term results of robot-assisted coronary artery bypass grafting (RACAB) in the treatment of multi-vessel coronary artery disease (MV-CAD). Methods Patients with MV-CAD who underwent RACAB from April 2018 to December 2021 in our hospital were included. Patients who underwent hybrid coronary revascularization (HCR) which combined RACAB with percutaneous coronary intervention were allocated to a HCR-RACAB group, and patients who underwent multi-vessel RACAB were allocated to a MV-RACAB group. Perioperative and follow-up data were collected and compared between the two groups. Results A total of 102 patients were included, including 81 males and 21 females with a mean age of 61.7±10.8 years. Two (2.0%) patients were transferred to conventional CABG due to sudden ventricular fibrillation and pleura adhesion. In the remaining 100 patients who underwent RACAB, 100 left internal mammary arteries (LIMA) and 46 right internal mammary arteries (RIMA) were harvested with a 100.0% success rate. Besides, all patients undergoing RACAB achieved LIMA/RIMA-left anterior descending branch reconstruction, with an average number of 2.5±0.6 target vessels revascularized by stent or graft. One patient had perioperative myocardial infarction with an outcome of death. The incidence of major perioperative adverse events was 1.0%. There was no perioperative stroke or re-sternotomy for hemostasis. The mean follow-up time was 28.2 months, with a follow-up rate of 99.0% and an overall major adverse cardiac and cerebrovascular event (MACCE) rate of 7.0%, including 3 all-cause deaths (3.0%), 2 strokes (2.0%) and 3 re-revascularizations (3.0%). The HCR-RACAB group had fewer red blood cell transfusion (P=0.030) and intraoperative blood loss (P=0.037) compared with the MV-RACAB group, and there was no statistical difference in the incidence of major perioperative adverse events or MACCE between the two groups during the follow-up period (P>0.05). Conclusion RACAB can be safely applied in the treatment of MV-CAD with good early and mid-term outcomes. High-quality harvesting of LIMA/RIMA and aortic no-touch technique are crucial to achieve these results.

Citation： XIE Yuqian, ZHANG Liyue, CHENG Nan, DONG Shiyong, SHEN Hua, WANG Rong. Robot-assisted minimally invasive coronary artery bypass in treating multi-vessel coronary artery disease: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(5): 724-730. doi: 10.7507/1007-4848.202210041 Copy

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11.	Head SJ, Milojevic M, Taggart DP, et al. Current practice of state-of-the-art surgical coronary revascularization. Circulation, 2017, 136(14): 1331-1345.
12.	Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
13.	McGinn JT, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting: Dual-center experience in 450 consecutive patients. Circulation, 2009, 120(11 Suppl): S78-S84.
14.	Gaudino M, Bakaeen F, Davierwala P, et al. New strategies for surgical myocardial revascularization. Circulation, 2018, 138(19): 2160-2168.
15.	Nambiar P, Kumar S, Mittal CM, et al. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future? J Thorac Cardiovasc Surg, 2018, 155(1): 190-197.
16.	Davierwala PM, Verevkin A, Sgouropoulou S, et al. Minimally invasive coronary bypass surgery with bilateral internal thoracic arteries: Early outcomes and angiographic patency. J Thorac Cardiovasc Surg, 2021, 162(4): 1109-1119.
17.	Hemli JM, Patel NC. Robotic cardiac surgery. Surg Clin North Am, 2020, 100(2): 219-236.
18.	Narayan P, Angelini GD. Robotic hybrid coronary revascularization―A need for strategy specific data. J Card Surg, 2022, 37(3): 512-514.
19.	Wang C, Li P, Zhang F, et al. Is hybrid coronary revascularization really beneficial in the long term? Eur J Cardiothorac Surg, 2021, 60(5): 1158-1166.
20.	Thuijs DJFM, Kappetein AP, Serruys PW, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet, 2019, 394(10206): 1325-1334.

1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the global burden of disease study 2019. Lancet, 2020, 396(10258): 1204-1222.
2. Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 145(3): e18-e114.
3. Loulmet D, Carpentier A, d'Attellis N, et al. Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments. J Thorac Cardiovasc Surg, 1999, 118(1): 4-10.
4. Torregrossa G, Balkhy HH. The role of robotic totally endoscopic coronary artery bypass in the future of coronary artery revascularization. Eur J Cardiothorac Surg, 2020, 58(2): 217-220.
5. Yang M, Wu Y, Wang G, et al. 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(4): 1367-1373.
6. Yang M, Gao CQ, Wu Y, et al. Robotic internal thoracic artery harvesting and the mid-term follow up of arterial graft patency. Zhonghua Yi Xue Za Zhi, 2013, 93(6): 428-431.
7. 成楠, 杨明, 王明岩, 等. 机器人辅助获取双侧乳内动脉行微创冠状动脉旁路移植术治疗冠心病多支血管病变. 机器人外科学杂志, 2020, 1(1): 43-49.
8. Harskamp RE, Brennan JM, Xian Y, et al. Practice patterns and clinical outcomes after hybrid coronary revascularization in the United States: An analysis from the society of thoracic surgeons adult cardiac database. Circulation, 2014, 130(11): 872-879.
9. Moreno PR, Stone GW, Gonzalez-Lengua CA, et al. The hybrid coronary approach for optimal revascularization: JACC review topic of the week. J Am Coll Cardiol, 2020, 76(3): 321-333.
10. McCaffrey DF, Griffin BA, Almirall D, et al. A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med, 2013, 32(19): 3388-3414.
11. Head SJ, Milojevic M, Taggart DP, et al. Current practice of state-of-the-art surgical coronary revascularization. Circulation, 2017, 136(14): 1331-1345.
12. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
13. McGinn JT, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting: Dual-center experience in 450 consecutive patients. Circulation, 2009, 120(11 Suppl): S78-S84.
14. Gaudino M, Bakaeen F, Davierwala P, et al. New strategies for surgical myocardial revascularization. Circulation, 2018, 138(19): 2160-2168.
15. Nambiar P, Kumar S, Mittal CM, et al. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future? J Thorac Cardiovasc Surg, 2018, 155(1): 190-197.
16. Davierwala PM, Verevkin A, Sgouropoulou S, et al. Minimally invasive coronary bypass surgery with bilateral internal thoracic arteries: Early outcomes and angiographic patency. J Thorac Cardiovasc Surg, 2021, 162(4): 1109-1119.
17. Hemli JM, Patel NC. Robotic cardiac surgery. Surg Clin North Am, 2020, 100(2): 219-236.
18. Narayan P, Angelini GD. Robotic hybrid coronary revascularization―A need for strategy specific data. J Card Surg, 2022, 37(3): 512-514.
19. Wang C, Li P, Zhang F, et al. Is hybrid coronary revascularization really beneficial in the long term? Eur J Cardiothorac Surg, 2021, 60(5): 1158-1166.
20. Thuijs DJFM, Kappetein AP, Serruys PW, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet, 2019, 394(10206): 1325-1334.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Robot-assisted minimally invasive coronary artery bypass in treating multi-vessel coronary artery disease: A retrospective study in a single center

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