Balkhy Husam H, Nisivaco Sarah, Tung Avery, Torregrossa Gianluca, Mehta Sachin
12246 Department of Cardiothoracic Surgery, University of Chicago Medicine, IL, USA.
21727 Department of Anesthesia, University of Chicago Medicine, IL, USA.
Innovations (Phila). 2020 Sep/Oct;15(5):456-462. doi: 10.1177/1556984520940462. Epub 2020 Aug 10.
Robotic off-pump totally endoscopic coronary artery bypass (TECAB) usually requires isolated single (right) lung ventilation to adequately expose the surgical site. However, in some patients, persistent oxygen desaturation may occur and conversion to cardiopulmonary bypass (CPB) or sternotomy may be necessary. We reviewed the characteristics and clinical outcomes in patients who did not tolerate single-lung ventilation during TECAB surgery.
After Institutional Review Board approval we reviewed 440 patients undergoing robotic TECAB at our institution between July 2013 and April 2019. Patients were separated into 2 groups based on their ability to tolerate single-lung ventilation during the procedure. Group 1 included patients able to tolerate single-lung ventilation and Group 2 were patients who required double-lung ventilation to tolerate the procedure. Early and mid-term outcomes were compared.
Group 2 (121 patients) had higher Society of Thoracic Surgeons scores, higher body mass index, and more triple-vessel disease than Group 1 (319 patients). Group 2 had more bilateral internal mammary artery use, multivessel grafting, and longer operative times. One patient underwent conversion to sternotomy and 5 required CPB (all in Group 1). Intensive care unit and hospital length of stay were longer in Group 2. Observed/expected mortality did not differ between groups (1.06% in Group 2 vs 0.4% in Group 1; = 0.215). At mid-term follow-up, cardiac-related/overall mortality and freedom from major adverse cardiac events were similar.
In our cohort, intolerance of single-lung ventilation did not preclude robotic off-pump TECAB. Double-lung ventilation is feasible during the procedure and may prevent conversions to sternotomy or use of CPB, resulting in excellent early and mid-term outcomes.
机器人非体外循环完全内镜下冠状动脉搭桥术（TECAB）通常需要单肺（右侧）隔离通气以充分暴露手术部位。然而，在一些患者中，可能会出现持续性氧饱和度下降，可能需要转为体外循环（CPB）或开胸手术。我们回顾了TECAB手术期间不能耐受单肺通气患者的特征和临床结局。
经机构审查委员会批准后，我们回顾了2013年7月至2019年4月在本机构接受机器人TECAB手术的440例患者。根据患者在手术过程中耐受单肺通气的能力将其分为两组。第1组包括能够耐受单肺通气的患者，第2组是需要双肺通气才能耐受手术的患者。比较早期和中期结局。
第2组（121例患者）的胸外科医师协会评分更高、体重指数更高，三支血管病变比第1组（319例患者）更多。第2组使用双侧胸廓内动脉、多支血管移植和手术时间更长。1例患者转为开胸手术，5例需要CPB（均在第1组）。第2组的重症监护病房和住院时间更长。两组间观察到的/预期的死亡率无差异（第2组为1.０6%，第1组为0.4%；P = 0.215）。在中期随访时，心脏相关/总死亡率和无主要不良心脏事件的情况相似。
在我们的队列中，不能耐受单肺通气并不排除机器人非体外循环TECAB。手术过程中双肺通气是可行的，并且可以防止转为开胸手术或使用CPB，从而产生良好的早期和中期结局。
