Robotic-Assisted Coronary Artery Bypass Grafting vs. Percutaneous Coronary Intervention Strategies for Ostial Left Anterior Descending Lesions.

Abstract

Background: The comparison of outcomes of robotic-assisted coronary artery bypass grafting (RA-CABG) vs. stenting techniques (ostial or crossover stenting) for ostial left anterior descending (LAD) artery lesions is still lacking. This retrospective study sought to determine the midterm outcomes of RA-CABG, crossover stenting (CS), and ostial stent implantation (OSI) in patients with ostial LAD disease.

Methods: All cases were divided into 3 groups as follows: RA-CABG (group 1) (n = 157), CS (group 2) (n = 104), and OSI (group 3) (n = 178). The primary endpoint was defined  as  the major adverse cardiac and cerebral events (MACCE), which included cardiac death, target vessel myocardial infarction, target vessel revascularization (TVR), stroke, and stent thrombosis or symptomatic graft occlusion during follow-up. This is the first investigation comparing midterm outcomes of RA-CABG, CS, and OSI as revascularization options for ostial LAD lesions.

Results: A total of 439 consecutive individuals [male: 341 (77.6%), mean age: 59.58 ± 9.35 years] with ostial LAD disease were included in this study. The rates of MACCE (P = .020 for groups 3 vs. 1; P = .011 for groups 3 vs. 2) and clinically driven TVR (15.7 vs. 4.5%, P = .001 for groups 3 vs. 1; 15.7 vs. 5.8%, P = .014 for groups 3 vs. 2) were notably higher in group 3 than the others. The mid-term MACCE [(adjusted hazard ratio = 2.129  [95%  confidence interval: 1.360-3.334], P = .001)]  in  the  overall  population  significantly  differed  between group 3 and the others.

Conclusion:  The findings of the study suggest that OSI for ostial LAD lesions was associated with higher midterm MACCE and TVR rates than revascularization with RA-CABG or CS.