Robot-Assisted Minimally Invasive Coronary Artery Bypass Grafting: Total Arterial Revascularization Using the Double-Docking Technique.

Meeranghani Mohammed Yusuf, Varun Bansal, Ashwin Venkatesh, Ganapathy Arumugam Chandrasekharan, Minal Vora, Aishwarya Mahesh Kumar
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Abstract

Objective: The right internal mammary artery is considered to be the second choice for arterial conduits for coronary artery bypass grafting (CABG). However, the widespread use of bilateral internal mammary artery (BIMA) grafting is limited owing to increased technical demands, lengthy procedure, and high incidence of sternal wound complications. We compared the early clinical outcomes of a novel robot-assisted double-docking technique (DDT) with an open sternotomy technique for total arterial revascularization using BIMA.

Methods: Between June 2019 and June 2023, 445 patients with multivessel coronary artery disease underwent open sternotomy CABG using BIMA grafting and 145 patients underwent robot-assisted BIMA grafting using DDT. Comparative analysis of 104 pairs of matched patients obtained using propensity score matching was performed. Procedural characteristics, postoperative 30-day mortality, and composite outcome (major adverse cardiac and cerebrovascular events) at a median follow-up of 1.5 years were evaluated.

Results: Preprocedural characteristics were well balanced between the groups after propensity matching. The number of distal anastomoses performed in the conventional group was statistically higher than that performed using DDT (P < 0.001). The durations of postsurgical ventilation, intensive care unit stay, and in-hospital stay were significantly lower with the DDT than with conventional CABG (P < 0.001). There was no significant difference in all-cause mortality or major adverse cardiac events between the DDT and conventional CABG groups at a median follow-up of 1.5 years.

Conclusions: The DDT is feasible and efficacious for revascularization of multiple coronary targets in select individuals. It is equivalent to open sternotomy in terms of early clinical outcomes and superior to open sternotomy with regard to rates of sternal infection and intensive care unit and in-hospital stay.

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机器人辅助微创冠状动脉旁路移植术:使用双对接技术进行全动脉再血管化。
目的:右乳内动脉被认为是冠状动脉旁路移植术(CABG)动脉导管的第二选择。然而,由于技术要求提高、手术时间长、胸骨伤口并发症发生率高,双侧乳内动脉(BIMA)移植术的广泛应用受到限制。我们比较了新型机器人辅助双对接技术(DDT)与开放式胸骨切开技术在使用BIMA进行全动脉血管再通的早期临床效果:2019年6月至2023年6月期间,445名多血管冠状动脉疾病患者接受了使用BIMA移植术的开胸CABG,145名患者接受了使用DDT的机器人辅助BIMA移植术。采用倾向评分匹配法对104对匹配患者进行了比较分析。对手术特征、术后30天死亡率以及中位随访1.5年的综合结果(主要不良心脑血管事件)进行了评估:结果:经过倾向匹配后,两组患者的术前特征非常均衡。在统计学上,常规组进行的远端吻合次数高于使用 DDT 进行的吻合次数(P < 0.001)。DDT 组的术后通气时间、重症监护室住院时间和住院时间均显著低于常规 CABG 组(P < 0.001)。在中位随访1.5年期间,DDT组和传统CABG组在全因死亡率或主要心脏不良事件方面没有明显差异:结论:DDT 对特定人群的多冠状动脉靶点血运重建是可行且有效的。就早期临床效果而言,它与开胸胸骨切开术相当,而在胸骨感染率、重症监护室和住院时间方面则优于开胸胸骨切开术。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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