Christidis Nickolas K, Fox Stephanie A, Swinamer Stuart A, Bagur Rodrigo, Sridhar Kumar, Lavi Shahar, Iglesias Ivan, Bainbridge Daniel, Jones Philip M, Harle Christopher C, Chu Michael W A, Teefy Patrick, Kiaii Bob B
From the Divisions of Cardiac Surgery and.
Cardiology, and.
Innovations (Phila). 2018 Nov/Dec;13(6):423-427. doi: 10.1097/IMI.0000000000000566.
Conversion to sternotomy is a primary bailout method for robotically assisted coronary artery bypass grafting procedures. The aims of this study were to identify the primary reasons for conversion from robotically assisted coronary artery bypass grafting to sternotomy and to evaluate the in-hospital outcomes in such patients.
Prospectively collected data from February 2004 to April 2017 were reviewed for 72 patients (56 men; mean age = 63.8 years) who required conversion to sternotomy during a robotically assisted coronary artery bypass grafting procedure with planned endoscopic left internal thoracic artery harvest and anastomosis to the left anterior descending on the beating heart.
The overall rate of conversion was 12.4% (72/581). Conversions occurred either during attempted endoscopic left internal thoracic artery harvest (31.9%), during endoscopic left anterior descending isolation (40.3%), during manual isolation and anastomosis of the left anterior descending (19.4%), or after anastomosis due to unsatisfactory flow (8.3%). Overall, the most common reason for conversion was an intramyocardial left anterior descending (43.1%). The median stay in the intensive care unit was 1 day (range = 0-20) and the median hospital length of stay was 5 days (range = 3-43). In-hospital complications included new atrial fibrillation (16.7%), need for blood transfusion (20.8%), mediastinitis (4.2%), postoperative myocardial infarction (2.8%), exploration for bleeding (2.8%), and 1 in-hospital death.
The reasons for conversion were primarily related to anatomical factors that created difficulties for endoscopic left internal thoracic artery harvesting and left anterior descending identification. Patients who required conversion to sternotomy from robotically assisted coronary artery bypass grafting demonstrated acceptable outcomes and low complication rates.
转为胸骨切开术是机器人辅助冠状动脉搭桥手术的主要补救方法。本研究的目的是确定从机器人辅助冠状动脉搭桥手术转为胸骨切开术的主要原因，并评估此类患者的院内结局。
回顾性分析2004年2月至2017年4月前瞻性收集的数据，纳入72例患者（56例男性；平均年龄=63.8岁），这些患者在计划采用内镜下获取左乳内动脉并在跳动心脏上与左前降支吻合的机器人辅助冠状动脉搭桥手术过程中需要转为胸骨切开术。
总体转换率为12.4%（72/581）。转换发生在尝试内镜下获取左乳内动脉期间（31.9%）、内镜下分离左前降支期间（40.3%）、手动分离并吻合左前降支期间（19.4%）或吻合后因血流不满意（8.3%）。总体而言，转换的最常见原因是左前降支心肌内走行（43.1%）。重症监护病房的中位住院时间为1天（范围=0-20天），医院中位住院时间为5天（范围=3-43天）。院内并发症包括新发房颤（16.7%）、输血需求（20.8%）、纵隔炎（4.2%）、术后心肌梗死（2.8%）、探查出血（2.8%）以及1例院内死亡。
转换的原因主要与解剖因素有关，这些因素给内镜下获取左乳内动脉和识别左前降支带来困难。从机器人辅助冠状动脉搭桥手术转为胸骨切开术的患者显示出可接受的结局和较低的并发症发生率。
