Comparative Study On Clinical And Quality Of Life Between Off-pump Robotic And Sternotomy Coronary Artery Bypass Grafting

Objective: Based on more than200clinical samples, this research compared theimportant parameters regarding the effectiveness, safety and early and medium-termrecover quality of life between the TECAB and OPCAB. The aim of this study is toprovide data to for the choice between TECAB and OPCAB.Methods:1. Samples:In the period of2007.1-2014.2, the PLA main hospital carried out71coronary arterybypass graft operation using da Vinci robotic system, which was chosen as the roboticgroup. In the same period,131off-pump coronary artery bypass graft operation wasalso carried out, which was chosen as the OPCAB group.2. Methods:(1) TECAB group: da Vinci System was used for the isolation of skeletonized internalmammary artery. Under the condition of complete not open chest, no damage to thesternum and ribs, sternum, ribs and heart beating, we applied the a dedicated heartstabilizer to fix the heart target vessel anastomosis site. Based on the robotic operationsystem, the operator completed bridge vascular anastomosis using the mechanicalarm.(2)OPCAB group: First open chest at the anterior median site. Than fix the hearttarget vessel anastomosis site using the Medtronic Octopus heart stabilizer, and theleft internal mammary artery and target vessel anastomosis was accomplishedmanually. For the other target vessels, use the great saphenous vein for sequentialanastomosis, and anastomose the proximal saphenous vein with the ascending aorta.(3) Measure the graft flow with ultrasonic flow measurement instrument (TTFM) afterthe completion of anastomosis. 3. Collection of two groups of perioperative clinical data, including:preoperative data, operation time, the time of vascular anastomosis, bridge vascularblood flow, intraoperative and postoperative bleeding, mechanical ventilation time,ICU time, postoperative hospital stay and postoperative complications.4. Postoperative follow-up:Follow up the major adverse cardiovascular events (MACE) and the graft vascularanastomosis patency rate of the internal mammary artery in the early andmedium-term through hospital review and telephone follow up. MACE includes:sudden cardiac death, myocardial infarction, stroke and interventional treatment. Thegraft vascular anastomosis patency rate of the internal mammary artery: use the64-MSCTA to evaluate the patency rate of LIMA graft anastomotic stoma at0.5–1year,1year–3year, and3year–5year post operation.Results:1. All the operations were successful which were proved by0death rate. Noearly-stage complication was discovered for TECAB group. Although the theearly-stage complication rate was3.8%for OPCAB group, no significant differenceswas found between the TECAB and OPCAB group (P>0.05). The early andmedium-term MACE rate was0%and3.8%for TECAB and OPCAB, respectively.2. The achievement ratio of the internal mammary artery was100%. The averagevolume of blood flow for TECAB internal mammary artery arterial bridge was35.8±20.5ml/min, which was higher than the OPCAB group (21.3±12.5ml/min)(P<0.05). The graft vascular anastomosis patency rate of the internal mammary arteryfor TECAB group was100.0%and100.0%for0.5–1year and1year–3year postoperation, respectively, which was found to be not significantly different to theOPCAB group (P>0.05).3. The parameters such as amount of intraoperative bleeding, postoperative drainage,ventilation time, ICU time and the postoperative hospitalization time of TECABgroup were found to be significantly better than the OPCAB group (p<0.05). No death,respiratory system complication, nervous system complication and urinary systemcomplication was found for both groups. The incidence of new onset atrial fibrillation was significantly lower for the TECAB group to the median OPCAB group.4. The survey of30-day postoperative life quality revealed that the score of7dimensions out of9dimensions of SF-36chart was significantly higher for theTECAB group compared with median OPCAB group. The postoperative incision painand the scale to which the pain affects life quality was found to be significantly lowerfor the TECAB group compared with median OPCAB group (p<0.05). The time ofback to work and complete recovery to activities were found to be significantlyshorter for the TECAB group compared with median OPCAB group (p<0.05), and thewound recovery satisfaction rate was also found to be higher for the TECAB group(p<0.05).Conclusions:1. The complication rate, death rate and graft vascular anastomosis patency rate of theinternal mammary artery between the TECAB and OPCAB groups were found to benot significantly different. The TECAB applied the isolation of skeletonized internalmammary artery, which help to achieve better in-operation blood flow.2. The robotic coronary artery bypass graft (TECAB) was safe and reliable, whichwas proved by its low surgical trauma, low in-operation and post-operation blooddrainage, less post-operation pain, less complications, shorter back-to-work period,better satisfaction of wound recovery, high score of post-operation life quality andbetter medium-term operation effect. The TECAB was a good choice of minimallyinvasive cardiac operation.