title: Hybrid coronary revascularization using robotic totally endoscopic surgery: perioperative outcomes and 5-year results.
abstract: BACKGROUND
  Hybrid coronary revascularization combines minimally invasive coronary artery bypass grafting and catheter-based interventions. This treatment option represents a viable alternative to both open multivessel coronary bypass surgery through sternotomy and multivessel percutaneous coronary intervention. The surgical component of hybrid coronary intervention can be offered in a completely endoscopic fashion using robotic technology. We report on one of the largest series to date.
  
  
  METHODS
  From 2001 to 2011, 226 patients (age, 61 years [range, 31 to 90 years]; 77.0% male; EuroSCORE, 2 [range, 0 to 13]) underwent hybrid coronary interventions on an intention-to-treat basis. Robotically assisted procedures were performed using the daVinci, daVinci S, and daVinci Si surgical telemanipulation systems (Intuitive Surgical, Inc, Sunnyvale, CA) and included 147 single, 72 double, and 7 triple endoscopic coronary artery bypass grafting procedures. Surgery was carried out first in 160 cases (70.8%), percutaneous coronary intervention was carried out first in 38 cases (16.8%), and 28 patients underwent simultaneous operations in a hybrid operating room (12.4%). Drug-eluting stents were used in 70.0% of the patients.
  
  
  RESULTS
  Hospital mortality was 3 of 226 patients (1.3%), and hospital stay averaged 6 days (range, 3 to 54 days). Patients walked outside 7 days (range, 3 to 97 days) postoperatively and performed general household work 14 days (range, 7 to 180 days) postoperatively. Full activity was resumed at 42 days (range, 7 to 720 days). Five-year survival was 92.9%, and 5-year freedom from major adverse cardiac and cerebral events was 75.2%. At 5 years, 2.7% of bypass grafts and 14.2% of percutaneous coronary intervention targets needed reintervention.
  
  
  CONCLUSIONS
  Robotically assisted hybrid coronary intervention enables surgical treatment of multivessel coronary artery disease with minimal trauma. Perioperative results and intermediate-term outcomes meet the standards of open coronary artery bypass grafting. Recovery time is short, and reintervention rates are acceptable.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. johannesbonatti@gmail.com
authors.forename: Johannes O
authors.initials: JO
authors.lastname: Bonatti
authors.forename: David
authors.initials: D
authors.lastname: Zimrin
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lehr
authors.forename: Mark
authors.initials: M
authors.lastname: Vesely
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
authors.forename: Brody
authors.initials: B
authors.lastname: Wehman
authors.forename: Andreas R
authors.initials: AR
authors.lastname: de Biasi
authors.forename: Benedikt
authors.initials: B
authors.lastname: Hofauer
authors.forename: Felix
authors.initials: F
authors.lastname: Weidinger
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachner
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
authors.forename: Guy
authors.initials: G
authors.lastname: Friedrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D059035:Perioperative Period; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome