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Association of Robotic Totally Endoscopic Coronary Artery Bypass Graft Surgery Associated with a Preliminary Cardiac Enhanced Recovery after Surgery Program: A Retrospective Analysis

par Zaouter, Cédrick;Imbault, Julien;Labrousse, Louis;Abdelmoumen, Youssef;Coiffic, Alain;Colonna, Giorgio;Jansens, Jean-Luc ;Ouattara, Alexandre
Référence Journal of cardiothoracic and vascular anesthesia, 29, 6, page (1489-1497)
Publication Publié, 2015-12

Article révisé par les pairs

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Résumé :

Objectives The robotic totally endoscopic coronary artery bypass graft (TECAB) surgery reduces patients' recovery time. The present trial investigated the feasibility and safety of an initial enhanced recovery after surgery (ERAS) path for patients undergoing robotic beating-heart TECAB and compared it with both conventional surgery and traditional perioperative care. It was hypothesized that the preliminary ERAS pathway associated with a beating-heart TECAB procedure could have a synergistic effect on postoperative patient care. Design Observational retrospective study. Setting University hospital. Participants Patients scheduled for coronary artery bypass graft and undergoing robotic beating-heart TECAB (n = 38) were compared with those undergoing standard surgery and perioperative care (n = 33). The outcomes were the possibility of tracheal extubation at the end of the surgery and the incidence of postoperative complications. Measurements and Main Results The main comorbidities were similar between the 2 groups. Extubation on the operating table in the TECAB group was possible in all cases without requiring prompt endotracheal tube reinsertion. The proportion of patients transfused was significantly lower in the TECAB group (p = 0.009). In addition, the duration of intensive care unit and hospital stay were reduced significantly by 24 hours and by 4 days, respectively, in the TECAB group compared with the standard group (p< 0.05). Conclusions The present results suggested that a program coupling a beating-heart TECAB with a preliminary ERAS path for patients requiring a single coronary revascularization is feasible and safe. This approach could reduce postoperative mechanical ventilation time, transfusion rate, and both intensive care unit and hospital stay.