Key result
Robotic-assisted CABG linked to declining long-term MACCE, with 30-day mortality dropping to ~0.9%.
Observational (n=2,280)
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BACKGROUND: Patients who are not candidates for traditional coronary artery bypass grafting (CABG) and amenable only for percutaneous coronary intervention (PCI) with stents can receive the "gold standard" left internal thoracic artery (LITA) to left anterior descending artery (LAD) anastomosis through robotic-assisted CABG and PCI to non-LAD coronary targets. AIMS: We aimed to analyse clinical outcomes of robotic-assisted CABG. METHODS: A total of 2,280 consecutive patients who had undergone robotic-assisted CABG between May 2005 and June 2021 were included in our study. Robotic-assisted LITA harvest was followed by LITA-LAD manual anastomosis through a 4 cm left thoracotomy. Hybrid coronary intervention (HCR) consists of stent implantation in a non-LAD coronary artery performed within 7 days after robotic-assisted LITA-LAD. We performed a propensity-adjusted analysis comparison after dividing all robotic-assisted CABG patients into three time periods: 2005-2010, 615 patients; 2011-2016, 904 patients; and 2017-2021, 761 patients. RESULTS: The mean age increased from 64.5 years in the first time period to 65.8 years in the second time period to 68.1 years in the third (p<0.0001). Operative time was progressively reduced in the three periods (6.4; 6.2; 5.5 hours; p<0.001). The incidence of conversion to sternotomy remained similar for each period (1.8%; 1.7%; 1.5%; p=0.53). Thirty-day mortality in the three periods included 9 (1.4%), 9 (1.0%), and 7 (0.9%) patients, respectively (p=0.91), while 8 (0.3%) patients had PCI with stents in the entire group. The mean follow-up for the entire population was 4.2 years. At follow-up, the rates of all-cause death, major adverse cardiac and cerebrovascular events, non-fatal stroke, and repeat revascularisation with stents were significantly decreased from the first to the last period (pË0.0001). CONCLUSIONS: Robotic-assisted CABG and HCR provide good long-term outcomes in patients who are not candidates for conventional CABG.
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Dokollari et al. (2023) conducted an observational in Coronary artery disease requiring surgical coronary artery revascularisation (n=2,280). Robotic-assisted coronary artery bypass grafting (CABG) and hybrid coronary intervention across three time periods (2005-2010, 2011-2016, 2017-2021) vs. Earlier surgical time periods (2005-2010 vs 2011-2016 vs 2017-2021) was evaluated on All-cause death, major adverse cardiac and cerebrovascular events, non-fatal stroke, and repeat revascularisation with stents (p=<0.0001). Robotic-assisted CABG showed significantly decreased long-term death, MACCE, stroke, and repeat stenting from 2005-2010 to 2017-2021 (p<0.0001), with 30-day mortality of 1.4%, 1.0%, and 0.9%.
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