Multivessel beating heart robotic myocardial revascularization increases morbidity and mortality

Area of Science:

• Cardiac Surgery
• Minimally Invasive Procedures
• Cardiovascular Disease Management

Background:

• Robotic-assisted myocardial revascularization, or total endoscopic coronary artery bypass (TECAB), is often reported in small patient cohorts undergoing single-vessel bypass.
• Limited data exists on the outcomes of multivessel TECAB procedures.

Purpose of the Study:

• To present outcomes from a large series of patients undergoing multivessel TECAB.
• To compare these outcomes with expected results from conventional coronary artery bypass grafting (CABG).

Main Methods:

• Retrospective review of 106 patients who underwent TECAB (72% multivessel) by a single experienced team.
• Comparison of observed outcomes with predicted outcomes using the Society of Thoracic Surgeons (STS) risk calculator.

Main Results:

• TECAB procedures involved single (28%), double (63%), triple (8%), and quadruple (1%) vessel bypasses.
• Major morbidity/mortality occurred in 21.7% of patients (4 deaths), with increased surgical time associated with higher morbidity and mortality.
• Compared to STS predicted outcomes, TECAB showed similar hospital length of stay but higher rates of prolonged ventilation, renal failure, morbidity, and mortality.

Conclusions:

• Multivessel TECAB does not appear to offer significant clinical advantages over conventional CABG.
• The procedure may be associated with increased risks of morbidity and mortality.