Robotic Beating-Heart Totally Endoscopic Coronary Artery Bypass: Impact of Chest Wall Dimensions in Single and Multivessel Bypass.

IF 1.6 Q2 SURGERY
Tatsuya Watanabe, Hiroto Kitahara, Sarah Nisivaco, Charocka Coleman, Brooke Patel, Husam H Balkhy
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Abstract

Objective: There can be anatomical constraints on patient selection for minimally invasive surgery. For example, robot-assisted coronary artery bypass was reported to be more challenging when patients had a cardiothoracic ratio >50% and a sternum-vertebra anteroposterior and transverse diameter ratio <0.45. We sought to examine the impact of chest wall anatomic parameters on surgical outcomes in our totally endoscopic coronary artery bypass (TECAB) procedures.

Methods: We retrospectively reviewed patients who underwent robotic TECAB, all of whom had a preoperative chest radiograph at our institution from July 2017 to October 2021. The cohort was divided into 2 groups, which were patients undergoing single-vessel grafting using the left internal thoracic artery (ITA; group 1) and patients undergoing multivessel grafting with bilateral ITA grafts (group 2). We measured several anatomical parameters from the preoperative chest radiograph.

Results: A total of 352 patients undergoing TECAB were retrospectively analyzed. After exclusions, 193 were included in this study. In group 1 (n = 91), no parameters correlated with operative time. In group 2 (n = 102), a significant negative correlation was observed between operative time and the sternum-vertebrae anteroposterior diameter (rs = -0.228, P = 0.022) and lung anteroposterior diameter (rs = -0.246, P = 0.013). To confirm these results in group 2, a propensity-matched analysis was performed and showed a statistically significant difference in surgical time based on chest anteroposterior diameters.

Conclusions: In single-vessel robotic TECAB, chest wall anatomic dimensions measured on chest radiograph did not affect operative time. In multivessel cases with bilateral ITA grafts, larger anteroposterior diameter correlated with shorter operative times.

机器人心跳-心脏全内镜冠状动脉搭桥术:单血管和多血管搭桥术中胸壁尺寸的影响。
目的:微创手术患者的选择可能会受到解剖结构的限制。例如,据报道,如果患者的心胸比例大于 50%,胸骨与椎体的前后径和横径之比大于 50%,那么机器人辅助冠状动脉搭桥术就更具挑战性:我们回顾性研究了2017年7月至2021年10月期间在我院接受机器人TECAB手术的患者,所有患者均有术前胸片。该组患者分为两组,即使用左胸内动脉(ITA)进行单血管移植的患者(第1组)和使用双侧ITA移植进行多血管移植的患者(第2组)。我们根据术前胸片测量了几个解剖参数:我们对 352 名接受 TECAB 手术的患者进行了回顾性分析。经排除后,193 例患者被纳入本研究。在第一组(91 人)中,没有参数与手术时间相关。在第2组(n = 102)中,观察到手术时间与胸骨-椎体前后径(rs = -0.228,P = 0.022)和肺脏前后径(rs = -0.246,P = 0.013)之间存在显著负相关。为了在第2组中证实这些结果,进行了倾向匹配分析,结果显示,根据胸部前胸直径,手术时间的差异具有统计学意义:在单血管机器人 TECAB 中,胸片上测量的胸壁解剖尺寸不会影响手术时间。在使用双侧ITA移植物的多血管病例中,前胸直径越大,手术时间越短。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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