Conversion of Endoscopic, Robotically Assisted Coronary Bypass: Incidence, Risk Factors, and Outcome

Abstract Background: The clinical and financial consequences of conversion from endoscopic (robotically assisted) atraumatic coronary artery bypass (EndoACAB) to sternotomy (converted EndoACAB) have not been previously reported. This study sought to identify the incidence, causes, predictive factors, and adverse consequences of converted EndoACAB. Methods: Between June 1996 and June 2003, 509 patients underwent EndoACAB, and an additional 20 EndoACAB patients underwent converted EndoACAB. Data from the patients requiring conversion to sternotomy were retrospectively reviewed using multivariate regression and computer matched with data from a cohort of patients who underwent primary sternotomy (SternCAB). Results: The overall rate of conversion was 3.8% (20/509). Causes were: inability to expose the target vessel(s) (9), unsuitable internal mammary artery (7), intrathoracic bleeding (2), and hemodynamic instability (2). There were no statistical differences in mortality or major morbidity between converted EndoACAB patients versus the computer-matched SternCAB patients ( P = not significant). Hospital costs for the converted EndoACAB patients were higher than for the successful EndoACAB patients, but not higher than the computer-matched SternCAB patients. Conclusions: The incidence of conversion of EndoACAB patients to sternotomy was low and often occurred under elective circumstances. The clinical and economic consequences of conversion were minimal.