Pasrija Chetan, Kon Zachary N, Ghoreishi Mehrdad, Lehr Eric J, Gammie James S, Griffith Bartley P, Bonatti Johannes, Taylor Bradley S
Swedish Heart and Vascular Institute, Seattle, WA USA.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Innovations (Phila). 2018 Jul/Aug;13(4):282-286. doi: 10.1097/IMI.0000000000000537.
Totally endoscopic coronary artery bypass (TECAB) with robotic distal anastomosis and robotic-assisted minimally invasive coronary artery bypass (RA-MIDCAB) with robotic internal mammary artery harvest and direct hand-sewn distal anastomosis via an anterior thoracotomy have both been reported as safe and efficacious. We compared hospital cost and short-term outcomes between these techniques.
Patients who underwent robotic-assisted minimally invasive single-vessel Coronary artery bypass grafting (2011-2014) were retrospectively reviewed. One hundred consecutive patients underwent either TECAB (n = 50) or RA-MIDCAB (n = 50). The two groups were sequential with TECAB performed by one surgeon in the first portion of the study interval and RA-MIDCAB by another surgeon in the latter. Demographics, short-term outcomes, and hospital cost data were compared between the two groups.
Patient demographics and preoperative risk factors were similar between the TECAB and RA-MIDCAB groups, as total operating room time. Cardiopulmonary bypass was used for 56% of TECAB and 0% of RA-MIDCAB cases (P < 0.001). Intensive care unit and hospital lengths of stay, along with postoperative morbidities, were similar between the two groups. Operative mortality was 2% in the TECAB and 0% in the RA-MIDCAB group (P = NS). Total hospital cost was significantly higher with TECAB compared with RA-MIDCAB (US $33,769 vs. $22,679, P < 0.001), which was primarily driven by operative costs (US $17,616 vs. $26,803, P < 0.001).
Totally endoscopic coronary artery bypass and RA-MIDCAB both demonstrated excellent short-term clinical outcomes. However, TECAB was associated with significantly higher hospital costs. Further comparisons, including long-term outcomes, patient satisfaction, and functional status, are needed to evaluate whether this additional cost is justified.
完全内镜下冠状动脉旁路移植术（TECAB）采用机器人进行远端吻合，以及机器人辅助微创冠状动脉旁路移植术（RA-MIDCAB）采用机器人获取胸廓内动脉并通过前外侧开胸进行直接手工缝合远端吻合，均已被报道为安全且有效的。我们比较了这两种技术的住院费用和短期结局。
对2011年至2014年接受机器人辅助微创单支冠状动脉旁路移植术的患者进行回顾性研究。连续100例患者接受了TECAB（n = 50）或RA-MIDCAB（n = 50）。两组为序贯性分组，在研究间隔的第一部分由一位外科医生进行TECAB，在后者由另一位外科医生进行RA-MIDCAB。比较两组的人口统计学、短期结局和住院费用数据。
TECAB组和RA-MIDCAB组的患者人口统计学和术前危险因素相似，总手术室时间也相似。56%的TECAB病例使用了体外循环，而RA-MIDCAB病例为0%（P < 0.001）。两组的重症监护病房和住院时间以及术后发病率相似。TECAB组的手术死亡率为2%，RA-MIDCAB组为0%（P = 无统计学意义）。与RA-MIDCAB相比，TECAB的总住院费用显著更高（33,769美元对22,679美元，P < 0.001），这主要是由手术费用驱动的（17,616美元对26,803美元，P < 0.001）。
完全内镜下冠状动脉旁路移植术和RA-MIDCAB均显示出优异的短期临床结局。然而，TECAB与显著更高的住院费用相关。需要进行进一步比较，包括长期结局、患者满意度和功能状态，以评估这种额外费用是否合理。
