Balkhy Husam H, Nisivaco Sarah, Kitahara Hiroto, McCrorey Mackenzie, Patel Brooke
From the Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL USA.
Innovations (Phila). 2018 Mar/Apr;13(2):108-113. doi: 10.1097/IMI.0000000000000481.
Patients with a high Society of Thoracic Surgeons (STS) predicted risk of mortality undergoing coronary artery bypass surgery are known to have worse outcomes. Less invasive approaches have been shown to improve morbidity and mortality for these patients. In this study, we examined perioperative outcomes in higher-risk patients undergoing robotic totally endoscopic beating heart coronary artery bypass surgery.
The STS predicted risk of mortality was reviewed for patients undergoing robotic totally endoscopic beating heart coronary artery bypass surgery at our institution between January 2013 and May 2017. We identified a higher-risk cohort (n = 50) and compared them to a lower-risk cohort (n = 220) during the same period. The higher-risk group was formed from patients with the 50 highest STS scores. Perioperative data were collected retrospectively.
There were 50 patients in the higher-risk group (mean STS score = 7.05 ± 4.9, mean age = 73 years) and 220 patients in the lower-risk group (mean STS score = 0.89 ± 0.6, mean age = 64 years). The higher-risk group had significantly greater rates of renal insufficiency, peripheral vascular disease, and lower ejection fraction. The incidence of postoperative re-exploration for bleeding, stroke, myocardial infarction, and prolonged ventilation was similar. Perioperative blood transfusion and hospital length of stay were greater in the higher-risk group. Mortality was lower in the higher-risk group (0% vs 1.8% P = 0.045). Cardiac-related mortality was similar at midterm follow-up.
We conclude that beating heart totally endoscopic beating heart coronary artery bypass surgery can be performed in patients with a higher STS predicted risk of mortality with excellent outcomes. Further studies are warranted to evaluate long-term results of totally endoscopic beating heart coronary artery bypass surgery in this challenging group of patients.
已知接受冠状动脉搭桥手术的患者若胸外科医师协会（STS）预测的死亡风险较高，则预后较差。已证明，对于这些患者，采用侵入性较小的手术方法可改善发病率和死亡率。在本研究中，我们调查了接受机器人全胸腔镜不停跳冠状动脉搭桥手术的高危患者的围手术期结局。
回顾了2013年1月至2017年5月在我院接受机器人全胸腔镜不停跳冠状动脉搭桥手术患者的STS预测死亡风险。我们确定了一个高危队列（n = 50），并将其与同期的低危队列（n = 220）进行比较。高危组由STS评分最高的50例患者组成。回顾性收集围手术期数据。
高危组有50例患者（平均STS评分为7.05±4.9，平均年龄73岁），低危组有220例患者（平均STS评分为0.89±0.6，平均年龄64岁）。高危组肾功能不全、外周血管疾病和射血分数较低的发生率明显更高。术后因出血、中风、心肌梗死和通气时间延长而再次手术探查的发生率相似。高危组围手术期输血和住院时间更长。高危组死亡率较低（0%对1.8%，P = 0.045）。中期随访时心脏相关死亡率相似。
我们得出结论，对于STS预测死亡风险较高的患者，可以进行不停跳全胸腔镜冠状动脉搭桥手术，且预后良好。有必要进一步研究评估在这一具有挑战性的患者群体中全胸腔镜不停跳冠状动脉搭桥手术的长期结果。
