title: Five hundred cases of robotic totally endoscopic coronary artery bypass grafting: predictors of success and safety.
abstract: BACKGROUND
  Robotic technology has enabled totally endoscopic coronary artery bypass (TECAB) grafting. Little information is available on factors associated with successful and safe performance of TECAB. We report a 10-year multicenter experience with 500 cases, elucidating on predictors of success and safety in TECAB procedures.
  
  
  METHODS
  Between 2001 and 2011, 500 patients (364 [73%] men; 136 [27%] women; median age [minimum-maximum] 60 years [31-90 years], median EuroSCORE 2 [0-13]), underwent TECAB. Single, double, triple, and quadruple TECAB was performed in 334, 150, 15, and 1 patient, respectively. Univariate analysis and binary regression models were used to identify predictors of success and safety. Success was defined as freedom from any adverse event and conversion procedure, safety was defined as freedom from major adverse cardiac and cerebral events, major vascular injury, and long-term ventilation.
  
  
  RESULTS
  Success and safety rates were 80% (400 cases) and 95% (474 cases), respectively. Intraoperative conversions to larger thoracic incisions were required in 49 (10%) patients. The median operative time was 305 minutes (112-1,050 minutes), and the mean lengths of stay in the intensive unit (ICU) and in hospital were 23 hours (11-1,048 hours) and 6 days (2-4 days), respectively. Independent predictors of success were single-vessel TECAB (p = 0.004), arrested-heart (AH)-TECAB (p = 0.027), non-learning curve case (p = 0.049), and transthoracic assistance (p = 0.035). The only independent predictor of safety was EuroSCORE (p = 0.002).
  
  
  CONCLUSIONS
  Single-vessel and multivessel TECAB procedures can be safely performed with good reproducible results. Predictors of success include procedure simplicity and non-learning curve cases, whereas predictors of safety are mainly associated with patient selection.
authors: Department of Cardiac Surgery, University of Maryland, Baltimore, Maryland; Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. nikolaos.bonaros@i-med.ac.at
authors: Nikolaos
authors: N
authors: Bonaros
authors: Thomas
authors: T
authors: Schachner
authors: Eric
authors: E
authors: Lehr
authors: Markus
authors: M
authors: Kofler
authors: Dominik
authors: D
authors: Wiedemann
authors: Patricia
authors: P
authors: Hong
authors: Brody
authors: B
authors: Wehman
authors: David
authors: D
authors: Zimrin
authors: Mark K
authors: MK
authors: Vesely
authors: Guy
authors: G
authors: Friedrich
authors: Johannes
authors: J
authors: Bonatti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy / Q000379:methods*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome