Ultrafast Track Robotic-Assisted Minimally Invasive Coronary Artery Surgical Revascularization

Author:

Tarola Christopher L.1,Al-Amodi Hussein A.1,Balasubramanian Sankar1,Fox Stephanie A.1,Harle Christopher C.2,Iglesias Ivan2,Sridhar Kumar3,Teefy Patrick J.3,Chu Michael W.A.1,Kiaii Bob B.1

Affiliation:

1. Division of Cardiac Surgery, Western University, London, Ontario, Canada.

2. Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada.

3. Department of Cardiology, Western University, London, Ontario, Canada.

Abstract

Objective Contemporary anesthetic techniques have enabled shorter sedation and early extubation in off-pump and minimally invasive coronary artery bypass (CABG) surgery. Robotic-assisted CABG represents the optimal surgical approach for ultrafast track anesthesia, with patients able to bypass the cardiac surgical intensive care unit with recovery in the postanesthesia care unit (PACU) and inpatient ward. Methods In-hospital postoperative outcomes from ninety patients who underwent either elective or urgent robotically-assisted CABG at our institution were reviewed. These patients were carefully selected by a multidisciplinary team to undergo fast-track anesthesia: extubation in the operating room, 4-hour recovery in the postanesthesia care unit and transfer to the inpatient ward. Intrathecal, paravertebral local, and patient-controlled anesthesia techniques were used to facilitate transition to oral analgesics. Results Average patient age was 61 ± 9 years. Sixty-six patients (73%) were male. Seventy cases were elective, and 20 patients required urgent revascularization. All patients underwent intraoperative angiography after graft construction, which revealed Fitzgibbon class A grafts. There were no in-hospital mortalities. One patient required re-exploration for bleeding, through the same minimally invasive incision, did not require conversion to sternotomy for bleeding, and was transferred to the intensive care unit postexploration for bleeding for standard postoperative care. Postoperative complications were limited to one superficial wound infection. The mean hospital length of stay was 3.5 ± 1.17 days. Conclusions In patients undergoing robotic-assisted CABG, ultrafasttrack cardiac surgery with immediate postprocedure extubation and transfer to the inpatient ward has been demonstrated to be safe with no increase in perioperative morbidity or mortality. It requires a dedicated heart team with a carefully selected group of patients. Avoiding cardiac surgical intensive care unit expedites recovery, with possible avoidance of infection and early discharge from hospital.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Surgery,Pulmonary and Respiratory Medicine

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1. Maximizing Minimally Invasive Cardiac Surgery With Enhanced Recovery (ERAS);Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery;2024-08-29

2. Minimally invasive coronary artery bypass grafting: a literature review;Annals of Laparoscopic and Endoscopic Surgery;2024-01

3. Update on minimally invasive cardiac surgery and enhanced recovery after surgery;Current Opinion in Anaesthesiology;2023-10-11

4. The current role and future perspectives of minimally invasive coronary artery bypass grafting;Journal of Visualized Surgery;2023-07

5. Postoperative Day 1 Discharge After Robotic Totally Endoscopic Coronary Bypass: The Ultimate in Enhanced Recovery After Surgery;Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery;2023-03

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