BACKGROUND Patients who are not candidates for traditional coronary artery bypass grafting (CABG) and amenable only for percutaneous coronary intervention (PCI) with stents can receive the "gold standard" left internal thoracic artery (LITA) to left anterior descending artery (LAD) anastomosis through robotic-assisted CABG and PCI to non-LAD coronary targets. AIMS We aimed to analyse clinical outcomes of robotic-assisted CABG. METHODS A total of 2,280 consecutive patients who had undergone robotic-assisted CABG between May 2005 and June 2021 were included in our study. Robotic-assisted LITA harvest was followed by LITA-LAD manual anastomosis through a 4 cm left thoracotomy. Hybrid coronary intervention (HCR) consists of stent implantation in a non-LAD coronary artery performed within 7 days after robotic-assisted LITA-LAD. We performed a propensity-adjusted analysis comparison after dividing all robotic-assisted CABG patients into three time periods: 2005-2010, 615 patients; 2011-2016, 904 patients; and 2017-2021, 761 patients. RESULTS The mean age increased from 64.5 years in the first time period to 65.8 years in the second time period to 68.1 years in the third (p<0.0001). Operative time was progressively reduced in the three periods (6.4; 6.2; 5.5 hours; p<0.001). The incidence of conversion to sternotomy remained similar for each period (1.8%; 1.7%; 1.5%; p=0.53). Thirty-day mortality in the three periods included 9 (1.4%), 9 (1.0%), and 7 (0.9%) patients, respectively (p=0.91), while 8 (0.3%) patients had PCI with stents in the entire group. The mean follow-up for the entire population was 4.2 years. At follow-up, the rates of all-cause death, major adverse cardiac and cerebrovascular events, non-fatal stroke, and repeat revascularisation with stents were significantly decreased from the first to the last period (pË0.0001). CONCLUSIONS Robotic-assisted CABG and HCR provides good long-term outcomes in patients who are not candidates for conventional CABG.

中文翻译：

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机器人辅助冠状动脉血运重建手术的长期临床结果。

背景 不适合传统冠状动脉旁路移植术 (CABG) 且仅适合接受带支架的经皮冠状动脉介入治疗 (PCI) 的患者可以接受“金标准”左胸内动脉 (LITA) 至左前降支 (LAD) 吻合术通过机器人辅助 CABG 和 PCI 到达非 LAD 冠状动脉靶点。目的 我们的目的是分析机器人辅助 CABG 的临床结果。方法 我们的研究纳入了 2005 年 5 月至 2021 年 6 月期间连续接受机器人辅助 CABG 的 2,280 名患者。机器人辅助 LITA 收获后，通过 4 厘米的左胸廓切开术进行 LITA-LAD 手动吻合。混合冠状动脉介入治疗 (HCR) 包括在机器人辅助 LITA-LAD 后 7 天内在非 LAD 冠状动脉中进行支架植入。我们将所有机器人辅助 CABG 患者分为三个时间段后进行了倾向调整分析比较：2005 年至 2010 年，615 名患者；2005 年至 2010 年，615 名患者；2011-2016年，904名患者；2017-2021 年，761 名患者。结果 平均年龄从第一个时间段的 64.5 岁增加到第二个时间段的 65.8 岁，再到第三个时间段的 68.1 岁 (p<0.0001)。三个阶段的手术​​时间逐渐缩短（6.4；6.2；5.5 小时；p<0.001）。每个时期中转胸骨切开术的发生率保持相似（1.8%；1.7%；1.5%；p=0.53）。三个时期的 30 天死亡率分别包括 9 例（1.4%）、9 例（1.0%）和 7 例（0.9%）患者（p=0.91），而 8 例（0.3%）患者接受了支架 PCI 治疗。团体。整个人群的平均随访时间为 4.2 年。随访时，全因死亡率、主要不良心脑血管事件、非致命性卒中和支架重复血运重建率从第一期到末期显着下降（p±0.0001）。结论 机器人辅助 CABG 和 HCR 为不适合接受传统 CABG 的患者提供了良好的长期结果。