Experience in setting up non-robotic minimally invasive direct coronary artery bypass grafting in a non-routine off-pump coronary artery bypass center

European journal of medical research, vol. 30, pp. 64

Abstract

Abstract Background The safety of minimally invasive direct coronary artery bypass (MIDCAB) has been proven. Nevertheless, reports on clinical outcomes in MIDCAB and the learning curve of this challenging technique in a non-routine off-pump coronary artery bypass (OPCAB) center are still limited. Here, we introduce our clinical outcomes of non-robotic MIDCAB. Methods Between August 2022 and March 2024, 72 consecutive patients with a mean age of 67.4 ± 9.5 years underwent non-robotic MIDCAB (defined as off-pump bypass grafting of the left internal mammary artery to the left anterior descending artery through left-sided mini-thoracotomy). We analyzed operation time and incidence of major adverse cardiac and cerebrovascular events (MACCE). Further, subgroup analyses included body mass index (BMI) with a cut-off of 30 kg/m2 [BMI ≧ 30: n = 18 (25.0%)] and body surface area (BSA) with a cut-off of 2.0 m2 [BSA ≧ 2.0: n = 34 (47.2%)]. Results All patients survived, whereas MACCE occurred in 4 patients (5.6%). By correlation analyses, no learning curve for operation time was observed in all cases analysis (p = 0.79), but MACCE (n = 4, 5.6%) exclusively observed in the first 34 patients. Furthermore, BMI ≧ 30 or BSA ≧ 2.0 was not significantly related to longer operation time (p = 0.42 and p = 0.52, respectively) and MACCE (p = 0.26 and p = 0.35, respectively). In addition, body size had no effect on operation time according to multiple regression analysis (p = 0.36). Conclusions Our study suggested that implementing non-robotic MIDCAB can be safely accomplished at a center with no previous routine in OPCAB surgery, even for patients with bigger body sizes. MACCE occurs more frequently in the early stages when adopting this surgical technique.

Authors 11

1. Yukiharu Sugimura Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

   Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany

2. Tomoyuki Suzuki Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

   Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany

3. Sebastian Johannes Bauer Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

   Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany

4. Friederike Irmgard Schoettler Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

   Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany

5. Moritz Benjamin Immohr Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

   Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany

6. Michael André Maliwa Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

7. Arash Mehdiani Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · University of Duisburg-Essen · West German Heart and Vascular Center Essen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

   Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany

8. Lachmandath Tewarie Aachen Department of Cardiac Surgery Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

9. G. Schaelte Aachen Department of Anesthesiology, Medical Faculty and

   RWTH Aachen University · Universitätsklinikum Aachen · Hermann-Josef-Krankenhaus Erkelenz

   Affiliation as printed

   Department of Anesthesiology, Intensive Care and Emergency Medicine, Hermann-Josef General Hospital Erkelenz, Erkelenz, Germany

   Department of Anesthesiology, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

10. Ajay Kumar Moza Aachen Department of Cardiac Surgery Medical Faculty and

    RWTH Aachen University · Universitätsklinikum Aachen

    Affiliation as printed

    Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

11. Payam Akhyari corresponding Aachen Department of Cardiac Surgery Medical Faculty and

    RWTH Aachen University · Universitätsklinikum Aachen · University of Duisburg-Essen · West German Heart and Vascular Center Essen

    Affiliation as printed

    Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany. Payam.Akhyari@uk-essen.de

    Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany. Payam.Akhyari@uk-essen.de

    Department of Cardiac Surgery, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

    Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany