Consequences of hybrid procedure addition to robotic-assisted direct coronary artery bypass

Feras Khaliel, Vincenzo Giambruno, Michael W.A. Chu, Kumar Sridhar, Patrick Teefy, Bob B. Kiaii

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Patients postcoronary artery revascularization surgery often receives blood product transfusion, which could delay their intensive care unit and hospital discharge.We investigated our robotic-assisted direct coronary artery bypass (RADCAB) transfusion rate to determine whether performing the minimal invasive coronary surgery with percutaneous coronary intervention in one stagewould increase the incidence of blood transfusion, morbidity, and length of stay. Methods: Between November 2003 and November 2015, 483 consecutive patients underwent RADCAB surgery. They were divided into two groups. Group 1 (147 patients; mean ± SD age, 61.2 ± 11 years; 23% females) underwent robotic-assisted hybrid coronary artery revascularization with left internal thoracic artery to the left anterior descending coronary artery with percutaneous coronary intervention to a nonleft anterior descending coronary artery vessel in the same stage. Group 2 (336 patients; mean ± SD age, 61.2 ± 10.5 years; 25% females) underwent nonhybrid RADCAB. Early and late postoperative follow-up at mean ± SD of 83.6 ± 11.1 months was obtained. Results: Blood transfusion rate in group 1 was statistically different, as illustrated in Table 2. Based on the intraoperative cardiac catheterization, the incidence of graft revision was higher in the nonhybrid group. There was no difference between the two groups in terms of renal failure, neurological complication, prolonged mechanical ventilation, and gastrointestinal bleed. Conclusions: Despite similar preoperative demographics in the two groups, we have observed a significant difference in the blood transfusion rate in group 1. However, this did not lead into a statistically significant re-exploration rate for bleeding. Hence, we assume that dual antiplatelet therapy usage in the hybrid group might be the cause of the increase in blood transfusion rate. Nevertheless, it did not affect postoperative morbidity and length of hospital stay. A randomized multicenter clinical trial is needed.

Original languageEnglish (US)
Pages (from-to)192-196
Number of pages5
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Issue number3
StatePublished - 2017
Externally publishedYes


  • Hybrid revascularization
  • Minimally invasive cardiac surgery (MICS)
  • Percutaneous coronary intervention.
  • Robotic CABG
  • Robotic cardiac surgery
  • Robotic-assisted direct coronary artery bypass (RADCAB)

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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