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Reasons for Conversion and Adverse Intraoperative Events in Robotically Enhanced Minimally Invasive Coronary Artery
Johan van der Merwe1, Filip Casselman1, Yvette Vermeulen1
137467 The Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
Innovations (Philadelphia, Pa.)
|May 22, 2020
Summary
Robotically enhanced minimally invasive direct coronary artery bypass grafting (RE-MIDCAB) has a 4.0% sternotomy conversion rate. Key reasons include lung adhesions and internal thoracic artery dysfunction, with renal dysfunction predicting conversion risk.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Surgical Technology
Background:
- Minimally invasive coronary artery bypass grafting (MIDCAB) offers advantages but involves a learning curve.
- Robotically enhanced MIDCAB (RE-MIDCAB) is an alternative to sternotomy, but conversion rates need evaluation.
Purpose of the Study:
- To identify reasons for sternotomy conversion during RE-MIDCAB procedures.
- To describe adverse intraoperative events and risk factors associated with conversion.
- To inform strategies for safe and sustainable RE-MIDCAB programs.
Main Methods:
- Retrospective review of 759 RE-MIDCAB patients from July 2002 to November 2018.
- Analysis of perioperative data, focusing on reasons for sternotomy conversion and intraoperative events.
- Statistical analysis to identify predictors of conversion, including premorbid renal dysfunction.
Main Results:
- Sternotomy conversion occurred in 4.0% of patients (n=30).
- Common conversion reasons included lung adhesions (36.7%) and internal thoracic artery (ITA) dysfunction (36.7%).
- Premorbid renal dysfunction was a significant predictor of sternotomy conversion.
Conclusions:
- RE-MIDCAB is a viable option for coronary artery procedures, but conversion awareness is crucial.
- Addressing factors like adhesions and ITA issues can improve safety.
- Careful patient selection and quality control are essential for successful RE-MIDCAB programs.
