与微创直接冠状动脉旁路移植术相比，机器人辅助冠状动脉旁路移植术可改善短期预后。
Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting.
作者信息
Gong Wenhui, Cai Junfeng, Wang Zhe, Chen Anqing, Ye Xiaofeng, Li Haiqing, Zhao Qiang
机构信息
Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
出版信息
J Thorac Dis. 2016 Mar;8(3):459-68. doi: 10.21037/jtd.2016.02.67.
BACKGROUND
Robot-assisted coronary artery bypass grafts (RACAB) utilizing the da Vinci surgical system are increasingly used and allow the surgeon to conveniently harvest internal mammary arteries (IMAs). The aim of this study was to compare the outcomes of off-pump RACAB and minimally invasive direct coronary artery bypass grafting (MIDCAB) in the short and medium term.
METHODS
We performed a retrospective review of 132 patients with single- or multiple-vessel coronary artery disease who underwent minimally invasive off-pump CABG (OPCAB) between May 2009 and May 2014. The patients were divided into two groups based on the surgical approach, MIDCAB and RACAB group. The anastomosis of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) was performed as regular OPCAB through the incision on the beating heart using regular stabilization devices (Genzyme Corporation). The preoperative, intraoperative, postoperative, and follow-up data, including major adverse cardiac and cerebrovascular events (MACCE), were compared.
RESULTS
The preoperative data were similar. RACAB significantly shorten the intensive care unit (ICU) stay and postoperative compared with the MIDCAB group (P<0.05). There were 12 (19.7%) patients treated with a two-stage hybrid procedure in the MIDCAB group and 34 (47.9%) patients in the RACAB group (P=0.001). Thirty-day mortality was 1.6% in the MIDCAB group. There were 9 (14.7%) MIDCAB patients and 2 (2.8%) RACAB patients (P=0.013) that developed new arrhythmia. The two groups showed comparable mid-term survival (P=0.246), but the MACCEs were significantly different (P=0.038).
CONCLUSIONS
RACAB may be a valuable alternative for patients requiring single or simple multi-vessel coronary artery bypass grafting (CABG). Although the mid-term mortality outcomes are similar, RACAB improves short-term outcomes and mid-term MACCE-free survival compared with MIDCAB.
背景
利用达芬奇手术系统的机器人辅助冠状动脉搭桥术（RACAB）应用日益广泛，使外科医生能够便捷地获取乳内动脉（IMA）。本研究旨在比较非体外循环RACAB与微创直接冠状动脉搭桥术（MIDCAB）的短期和中期疗效。
方法
我们对2009年5月至2014年5月期间接受微创非体外循环冠状动脉搭桥术（OPCAB）的132例单支或多支血管冠状动脉疾病患者进行了回顾性研究。根据手术方式将患者分为两组，即MIDCAB组和RACAB组。使用常规稳定装置（健赞公司），通过心脏跳动时的切口，按照常规OPCAB方法将左乳内动脉（LIMA）吻合至左前降支动脉（LAD）。比较术前、术中、术后及随访数据，包括主要不良心脑血管事件（MACCE）。
结果
术前数据相似。与MIDCAB组相比，RACAB显著缩短了重症监护病房（ICU）住院时间和术后住院时间（P<0.05）。MIDCAB组有12例（19.7%）患者接受了两阶段杂交手术，RACAB组有34例（47.9%）患者接受了该手术（P=0.001）。MIDCAB组30天死亡率为1.6%。有9例（14.7%）MIDCAB患者和2例（2.8%）RACAB患者发生了新的心律失常（P=0.013）。两组中期生存率相当（P=0.246），但MACCE有显著差异（P=0.038）。
结论
对于需要单支或简单多支血管冠状动脉搭桥术（CABG）的患者，RACAB可能是一种有价值的替代方案。虽然中期死亡率结果相似，但与MIDCAB相比，RACAB改善了短期疗效和中期无MACCE生存率。
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