• J. Thorac. Cardiovasc. Surg. · Aug 2024

    A Decade of Robotic Beating-Heart Totally Endoscopic Coronary Bypass (TECAB) at a Single Institution: Outcomes with 10-Year Follow-Up.

    • Sarah Nisivaco, Hiroto Kitahara, Riya Bhasin, Brooke Patel, Charocka Coleman, and Husam H Balkhy.
    • University of Chicago Medicine, Department of Cardiothoracic Surgery, Chicago, IL, USA.
    • J. Thorac. Cardiovasc. Surg. 2024 Aug 6.

    ObjectiveRobotic beating-heart totally-endoscopic coronary bypass (TECAB) is performed using single or bilateral ITAs (BITA) with good results. Despite slow adoption and limited industry support, we have evolved our practice and continue to routinely perform TECAB. We describe our series of 874 patients undergoing robotic beating-heart TECAB with up to 10-year follow-up.MethodsA retrospective review of all patients (n=874) undergoing robotic beating-heart TECAB (7/2013-4/2024) was performed. Patients were contacted for midterm follow-up, and angiographic data collected in those undergoing hybrid revascularization. Multivariate regression analysis and cox proportional hazard modeling were used to analyze risk factors (RFs) for early/midterm outcomes. Primary end-points were midterm all-cause mortality and MACCE.ResultsMean STS score was 1.5+2.2%. 470 (54%) underwent multivessel TECAB, of whom 86% received BITA. There was 1 intraoperative conversion (0.11%). Mean LOS was 2.3+0.8 days. Hospital mortality was 0.80% (O/E 0.54). 393 patients (45%) underwent hybrid revascularization. Early graft patency was 97% (LITA-LAD patency 98%). Midterm follow-up was 100% at mean 48 months (longest 10.6 years). Cardiac-related mortality and all-cause mortality were 2.2% and 18%, respectively. Freedom from MACCE was 93%. In multivariate analysis, left-main disease >70% was a RF for midterm cardiac mortality (OR 6.7, CI 1.9-24, P=0.003).ConclusionsIn this series of 874 patients with up to 10-year follow-up, we show that robotic TECAB can be performed with excellent early and midterm results using an iterative approach, despite significant challenges. Further industry support and wider surgeon adoption are necessary to ensure sustainability of this procedure.Copyright © 2024. Published by Elsevier Inc.

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