title: Multivessel beating heart robotic myocardial revascularization increases morbidity and mortality.
abstract: OBJECTIVE
  The vast majority of reports describing beating heart robotic myocardial revascularization (total endoscopic coronary artery bypass) contain very small numbers of patients undergoing single-vessel bypass. We present a large series of patients undergoing multivessel total endoscopic coronary artery bypass.
  
  
  METHODS
  We performed a retrospective clinical review of 106 patients undergoing total endoscopic coronary artery bypass (72% multivessel) at 1 institution by 1 experienced cardiac surgeon/physician assistant team. These results were compared with the expected clinical outcomes from conventional coronary artery bypass grafting calculated using the Society of Thoracic Surgeons risk calculator.
  
  
  RESULTS
  Of the 106 patients, 1% underwent quadruple total endoscopic coronary artery bypass, 8% triple, 63% double, and 28% single. The emergent conversion rate for hemodynamic instability was 6.6%. The postoperative renal failure rate (doubling of baseline serum creatinine or dialysis required) was 7.5%. Overall, 23 patients (21.7%) exhibited at least 1 major morbidity/mortality (4 deaths). The number of vessels bypassed (single/double/triple/quadruple) correlated positively with the surgical/operating room time, the lung separation time, vasoactive medication use, blood use, a postoperative ventilation time longer than 24 hours, intensive care unit length of stay, and hospital length of stay. An increased surgical time was significantly associated with major morbidity (P = .011) and mortality (P = .043). A comparison with the Society for Thoracic Surgeons expected outcomes revealed a similar hospital length of stay but an increased incidence of prolonged ventilation (P = .003), renal failure (P < .001), morbidity (P = .045), and mortality (P = .049).
  
  
  CONCLUSIONS
  Our results suggest that addressing multivessel coronary artery disease using total endoscopic coronary artery bypass offers no obvious clinical benefits and might increase the morbidity and mortality.
authors.affiliation: Department of Anesthesia and Critical Care, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA.
authors.forename: Richa
authors.initials: R
authors.lastname: Dhawan
authors.forename: Joseph Devin
authors.initials: JD
authors.lastname: Roberts
authors.forename: Kristen
authors.initials: K
authors.lastname: Wroblewski
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Katz
authors.forename: Jai
authors.initials: J
authors.lastname: Raman
authors.forename: Mark A
authors.initials: MA
authors.lastname: Chaney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002641:Chicago; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D004724:Endoscopy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology; D012121:Respiration, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D020521:Stroke / Q000209:etiology; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D003404:Creatinine