Robotic Multivessel Endoscopic Coronary Bypass: Impact of a Beating-Heart Approach With Connectors.

Background: Most robotic coronary bypass operations are single-vessel procedures. Very few centers perform totally endoscopic coronary artery bypass (TECAB), and even fewer perform multivessel grafting endoscopically. We hypothesized that a robotic beating-heart approach using distal anastomotic connectors facilitates multivessel TECAB with similar safety and efficacy to single-vessel TECAB.

Methods: We reviewed patients undergoing robotic TECAB at our institution between July 2013 and March 2018. There were 344 consecutive patients divided into two groups: multivessel (MV, group 1), and single-vessel (SV, group 2). We interrogated our prospectively collected database for preoperative, intraoperative, and postoperative outcomes to compare the groups.

Results: There were 197 patients in group 1 and 147 patients in group 2. Mean Society of Thoracic Surgeons scores were 1.69% ± 2.4% and 1.96% ± 3.5%, respectively (p = 0.389). Patients in group 1 were older, 67 ± 9.4 versus 63 ± 11.2 years (p < 0.001) and had more triple-vessel disease, 135 (69%) versus 31 (21%; p < 0.001). In group 1, 174 patients (88%) had bilateral internal mammary artery grafts and 13% had triple-vessel TECAB. Mean hospital stay was 3.07 ± 1.2 days in group 1 and 2.81 ± 1.4 days in group 2 (p = 0.072), and overall mortality was 1.45% (2.0% and 0.7%, respectively; p = 0.268). Graft patency (mean, 7 months) was 95.6% (151 of 158 grafts) in group 1 and 94.9% (37 of 39 grafts) in group 2 (p = 0.896).

Conclusions: Multivessel grafting is feasible during robotic beating-heart connector TECAB with good outcomes. We found no significant difference in mortality, hospital stay, midterm major adverse cardiac events, and interim graft patency compared with single-vessel TECAB. Further studies are warranted.