Factors causing prolonged mechanical ventilation and peri-operative morbidity after robot-assisted coronary artery bypass graft surgery
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Robot-assisted coronary artery bypass graft [robot-assisted (coronary artery bypass grafting (CABG)] surgery is the latest treatment for coronary artery disease. However, the surgery extensively affects cardiac and pulmonary function, and the risk factors associated with peri-operative morbidity, including prolong mechanical ventilation (PMV), have not been fully examined. In this retrospective cohort study, a total of 382 patients who underwent robot-assisted internal mammary artery harvesting with mini-thoracotomy direct-vision bypass grafting surgery (MIDCABG) from 2005 to 2012 at our tertiary care hospital were included. The definition of PMV was failure to wean from mechanical ventilation more than 48 h after the surgery. Risk factors for PMV, and peri-operative morbidity and mortality were analyzed with a multivariate logistic regression model. Forty-three patients (11.3%) developed PMV after the surgery, and the peri-operative morbidity and mortality rates were 38 and 2.6%, respectively. The risk factors for PMV were age, left ventricular ejection fraction (LVEF), the duration of one-lung ventilation for MIDCABG (beating time), and peak airway pressure at the end of the surgery. Furthermore, age and anesthesia time were found to be independent risk factors for peri-operative morbidity, whereas age, LVEF, and anesthesia time were the risk factors for peri-operative mortality. These findings may help physicians to properly choose patients for this procedure, and provide more attention to patients with higher risk after surgery to achieve better clinical outcomes.
KeywordsRobotic CABG Outcome Delayed extubation Risk factors
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Mohr FW, Morice MC, Kappetein AP, Feldman TE, Stahle E, Colombo A, Mack MJ, Holmes DR Jr, Morel MA, Van Dyck N, Houle VM, Dawkins KD, Serruys PW (2013) Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 381:629–638CrossRefPubMedGoogle Scholar
- 6.Rogers CA, Pike K, Angelini GD, Reeves BC, Glauber M, Ferrarini M, Murphy GJ (2013) An open randomized controlled trial of median sternotomy versus anterolateral left thoracotomy on morbidity and health care resource use in patients having off-pump coronary artery bypass surgery: the Sternotomy Versus Thoracotomy (STET) trial. J Thorac Cardiovasc Surg 146(2):306–316.e1-9Google Scholar
- 15.Argenziano M, Katz M, Bonatti J, Srivastava S, Murphy D, Poirier R, Loulmet D, Siwek L, Kreaden U, Ligon D, TECAB Trial Investigators (2006) Results of the prospective multicenter trial of robotically assisted totally endoscopic coronary artery bypass grafting. Ann Thorac Surg 81:1666–1674 (discussion 1674-1665) CrossRefPubMedGoogle Scholar
- 16.Gajic O, Dabbagh O, Park PK, Adesanya A, Chang SY, Hou P, Anderson H 3rd, Hoth JJ, Mikkelsen ME, Gentile NT, Gong MN, Talmor D, Bajwa E, Watkins TR, Festic E, Yilmaz M, Iscimen R, Kaufman DA, Esper AM, Sadikot R, Douglas I, Sevransky J, Malinchoc M (2011) Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med 183:462–470CrossRefPubMedGoogle Scholar
- 28.Srivastava S, Gadasalli S, Agusala M, Kolluru R, Naidu J, Shroff M, Barrera R, Quismundo S, Srivastava V (2006) Use of bilateral internal thoracic arteries in CABG through lateral thoracotomy with robotic assistance in 150 patients. Ann Thorac Surg 81:800–806 (discussion 806) CrossRefPubMedGoogle Scholar
- 32.Zangrillo A, Pappalardo F, Dossi R, Di Prima AL, Sassone ME, Greco T, Monaco F, Musu M, Finco G, Landoni G (2015) Preoperative intra-aortic balloon pump to reduce mortality in coronary artery bypass graft: a meta-analysis of randomized controlled trials. Crit Care 19:10CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Dogan S, Aybek T, Andressen E, Byhahn C, Mierdl S, Westphal K, Matheis G, Moritz A, Wimmer-Greinecker G (2002) Totally endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: report of forty-five cases. J Thorac Cardiovasc Surg 123:1125–1131CrossRefPubMedGoogle Scholar
- 34.Wiedemann D, Bonaros N, Schachner T, Weidinger F, Lehr EJ, Vesely M, Bonatti J (2012) Surgical problems and complex procedures: issues for operative time in robotic totally endoscopic coronary artery bypass grafting. J Thorac Cardiovasc Surg 143(639–647):e632Google Scholar
- 41.Leyvi G, Schechter CB, Sehgal S, Greenberg MA, Snyder M, Forest S, Mais A, Wang N, DeLeo P, DeRose JJ Jr (2016) Comparison of index hospitalization costs between robotic CABG and conventional CABG: implications for hybrid coronary revascularization. J Cardiothorac Vasc Anesth 30:12–18CrossRefPubMedGoogle Scholar