Mid-term Clinical Outcomes of Robotic-Assisted Reverse Hybrid Coronary Revascularization. A Single Center Experience

Outcomes of robotic-assisted reverse hybrid coronary revascularization (HCR) remain hindered. We aim to analyze mid-term clinical outcomes of robotic-assisted reverse HCR. METHODS All consecutive 285 patients that underwent reverse robotic-assisted HCR between 09/2005-07/2021 are included. Reverse HCR consists of percutaneous coronary intervention (PCI) with stent implantation in non-left anterior descending (LAD) coronary artery vessels performed within 30-days prior to robotic-assisted left internal thoracic artery (LITA) harvesting and LITA to LAD manual anastomosis through a 4-cm left minithoracotomy. Dual antiplatelet therapy was not interrupted on any patient. RESULTS Preoperatively, mean age was 70.2 (± 11.2) years old. Prior to surgery, a total of 168 patients received 1 stent, 112 patients 2 stents, and 5 patients 3 stents. Intraoperatively, mean OR time was 5.9 (± 1) hours, no case was converted to full sternotomy, while 9 (3.1%) patients received intraoperative blood products transfusions. Postoperatively, a low incidence of stroke 1 (0.3%), reoperation for bleeding 7 (2.4%), blood product transfusions 48 (16.8%), and hospital stay (4.8 days) was observed. At 30-day follow-up, 1 (0.3%) patient underwent PCI with stent on a surgical LITA-LAD anastomosis due to graft failure. Mean follow-up was 4.2-years. Reported mid-term outcomes included all-cause death in 31 patients (10.9%), MACCE in 102/285 (35.9%), nonfatal stroke in 2/285 (0.7%), MI in 17/285 (5.9%), and repeat intervention in 50/285 (17.5%) patients. CONCLUSION This single center study reports effective and safe clinical outcomes at mid-term follow-up of reverse HCR procedures for treatment of multivessel coronary artery disease.