[Clinical factors influencing surgical approach selection of robotic-enhanced minimally invasive coronary artery bypass grafting].
OBJECTIVE
To investigate clinical factors that influence the selection of minimally approach between minimally invasive direct coronary artery bypass (MIDCAB) and totally endoscopic coronary artery bypass (TECAB).


METHODS
From February 2007 to January 2013, patients were selected under uniform criteria. A total of 202 patients including 142 male and 60 female patients with age range from 33 to 80 years and average age of (59 ± 10) years were included and were all routinely prepared for TECAB. Either TECAB or MIDCAB was performed based on the intraoperative condition. There were 90 patients who underwent TECAB (TECAB group) and 112 patients who received MIDCAB surgery (MIDCAB group). Univariate analysis was used to compare preoperative, intraoperative and early postoperative parameters. Logistic multivariate regression analysis was used to discuss independent influencing factors of minimally invasive approach selection.


RESULTS
All of the patients successfully received TECAB or MIDCAB surgery without mortality, severe complications or conversion to sternotomy. The early and midterm follow up of graft patency (by computed tomography angiography) was satisfactory. The mean operative time was (160 ± 64)minutes, mean graft flow was (27 ± 18) ml/min. Univariate analysis showed that sex ratio (3.5 vs.1.8, t = 4.350, P = 0.037), weight [(69 ± 11)kg vs.(72 ± 11)kg, t = -1.979, P = 0.049], multivessel coronary disease (43.3% vs.60.7%, t = 6.051, P = 0.014), and learning curve case (4.4% vs.14.3%, t = 5.418, P = 0.02) were significant predictors of conversion to MIDCAB. By multivariate analysis, multivessel coronary disease (HR = 1.964, 95%CI: 1.049-3.680, P = 0.035) and learning curve case (HR = 4.538, 95%CI: 1.219-16.891, P = 0.024) were independent influencing factors of MIDCAB approach.


CONCLUSIONS
Robotic-assisted minimally invasive coronary artery bypass grafting can be performed safely and effectively either by TECAB or MIDCAB. Multivessel coronary disease and early learning curve cases are independent influencing factors of minimally invasive approach selection.
Department of Cardiovascular Surgery, People's Liberation Army General Hospital, Beijing 100853, China.
Nan
N
Cheng
Department of Cardiovascular Surgery, People's Liberation Army General Hospital, Beijing 100853, China. Email: gchq301@yahoo.cn.
Chang-qing
CQ
Gao
Department of Cardiovascular Surgery, People's Liberation Army General Hospital, Beijing 100853, China.
Ming
M
Yang
Department of Cardiovascular Surgery, People's Liberation Army General Hospital, Beijing 100853, China.
Yang
Y
Wu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome