Zhou Zhandong, Dilip Karikehalli A, Gleboff Anna, Nazem Ahmad, Green Gary Randall, Cherney Anton, Lutz Charles J
Department of Cardiac Surgery, St Joseph's Health Hospital, Syracuse, New York.
Ann Thorac Surg Short Rep. 2023 Dec 19;2(2):226-230. doi: 10.1016/j.atssr.2023.11.029. eCollection 2024 Jun.
This study compares 2 minimally invasive coronary revascularization approaches: robot-assisted multivessel minimally invasive direct coronary artery bypass (MIDCAB) and the hybrid approach combining MIDCAB with subsequent percutaneous coronary intervention.
A retrospective review was conducted on cases of robotic MIDCAB performed at our institution between 2012 and 2022. Two groups of patients were analyzed: the surgery group (undergoing robotic multivessel MIDCAB) and the hybrid group. Surgical procedures included robotic left internal mammary artery harvest and anastomosis, with percutaneous coronary intervention performed within 30 days in the hybrid group.
There were 105 patients in the surgery group and 81 patients in the hybrid group. Both groups had similar characteristics, except that the surgery group had older patients. There were no mortalities in either group. Postoperative atrial fibrillation rates were higher in the surgery group. Length of stay and other postoperative complications did not differ significantly between the groups.
Multivessel robotic MIDCAB can be safely performed with comparable outcomes to the hybrid approach. The hybrid technique, being less demanding, is the preferred in most centers. However, multivessel robotic MIDCAB offers the advantage of complete revascularization and potentially more durable results. Patients with complex non-left anterior descending lesions may not be suitable for the hybrid approach.
本研究比较了两种微创冠状动脉血运重建方法：机器人辅助多支血管微创直接冠状动脉旁路移植术（MIDCAB）以及将MIDCAB与后续经皮冠状动脉介入治疗相结合的杂交手术方法。
对2012年至2022年在本机构进行的机器人辅助MIDCAB病例进行回顾性研究。分析了两组患者：手术组（接受机器人辅助多支血管MIDCAB）和杂交组。手术操作包括机器人辅助下的左乳内动脉采集和吻合，杂交组在30天内进行经皮冠状动脉介入治疗。
手术组有105例患者，杂交组有81例患者。两组具有相似的特征，只是手术组患者年龄更大。两组均无死亡病例。手术组术后房颤发生率更高。两组的住院时间和其他术后并发症无显著差异。
多支血管机器人辅助MIDCAB可以安全实施，其结果与杂交手术方法相当。杂交技术要求较低，在大多数中心是首选。然而，多支血管机器人辅助MIDCAB具有完全血运重建的优势，且可能产生更持久的效果。患有复杂非左前降支病变的患者可能不适合杂交手术方法。
