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Consequences of Hybrid Procedure Addition to Robotic-Assisted Direct Coronary Artery Bypass
Feras Khaliel1, Vincenzo Giambruno, Michael W A Chu
1From the Departments of *Cardiac Surgery and †Cardiology, London Health Science Center, University of Western Ontario, London, Ontario, Canada.
Insights
Robotic-assisted hybrid coronary artery revascularization increased blood transfusion rates but did not impact postoperative morbidity or hospital stay. Further trials are needed to confirm findings in coronary artery bypass grafting patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Background:
- Coronary artery revascularization surgery patients often require blood transfusions, potentially delaying recovery.
- Robotic-assisted direct coronary artery bypass (RADCAB) is a minimally invasive surgical approach.
- Hybrid procedures combine surgical revascularization with percutaneous coronary intervention.
Purpose of the Study:
- To evaluate the transfusion rate in patients undergoing robotic-assisted hybrid coronary artery revascularization compared to non-hybrid RADCAB.
- To determine if the hybrid approach increases morbidity and length of hospital stay.
Main Methods:
- A retrospective study of 483 patients undergoing RADCAB between 2003 and 2015.
- Group 1: Robotic-assisted hybrid coronary artery revascularization (n=147).
- Group 2: Non-hybrid RADCAB (n=336).
Main Results:
- The hybrid group (Group 1) showed a statistically significant difference in blood transfusion rates.
- Graft revision incidence was higher in the non-hybrid group (Group 2).
- No significant differences were observed in renal failure, neurological complications, prolonged ventilation, or gastrointestinal bleeding between groups.
Conclusions:
- The hybrid approach led to a higher blood transfusion rate, possibly due to dual antiplatelet therapy.
- Despite increased transfusions, postoperative morbidity and length of hospital stay were not significantly affected.
- A randomized multicenter clinical trial is recommended to validate these findings.
Objective:
Patients postcoronary artery revascularization surgery often receives blood product transfusion, which could delay their intensive care unit and hospital discharge. We investigated our robotic-assisted direct coronary artery bypass (RADCAB) transfusion rate to determine whether performing the minimal invasive coronary surgery with percutaneous coronary intervention in one stage would increase the incidence of blood transfusion, morbidity, and length of stay.
Methods:
Between November 2003 and November 2015, 483 consecutive patients underwent RADCAB surgery. They were divided into two groups. Group 1 (147 patients; mean ± SD age, 61.2 ± 11 years; 23% females) underwent robotic-assisted hybrid coronary artery revascularization with left internal thoracic artery to the left anterior descending coronary artery with percutaneous coronary intervention to a nonleft anterior descending coronary artery vessel in the same stage. Group 2 (336 patients; mean ± SD age, 61.2 ± 10.5 years; 25% females) underwent nonhybrid RADCAB. Early and late postoperative follow-up at mean ± SD of 83.6 ± 11.1 months was obtained.
Results:
Blood transfusion rate in group 1 was statistically different, as illustrated in Table 2. Based on the intraoperative cardiac catheterization, the incidence of graft revision was higher in the nonhybrid group. There was no difference between the two groups in terms of renal failure, neurological complication, prolonged mechanical ventilation, and gastrointestinal bleed.
Conclusions:
Despite similar preoperative demographics in the two groups, we have observed a significant difference in the blood transfusion rate in group 1. However, this did not lead into a statistically significant re-exploration rate for bleeding. Hence, we assume that dual antiplatelet therapy usage in the hybrid group might be the cause of the increase in blood transfusion rate. Nevertheless, it did not affect postoperative morbidity and length of hospital stay. A randomized multicenter clinical trial is needed.
