Benefit of Robotic Beating-Heart Totally Endoscopic Coronary Artery Bypass in Octogenarians

Objective: An important advantage of robotic beating-heart totally endoscopic coronary artery bypass (TECAB) is early functional recovery, in which fragile patients like octogenarians (age >80 years) benefit most. The aim of this study was to investigate the safety and feasibility of TECAB in octogenarians. Methods: We retrospectively reviewed patients undergoing TECAB from July 2013 to September 2017 at our institution. Perioperative outcomes of octogenarian patients and that of younger patients were compared. Results: Of 308 patients who underwent TECAB, 28 patients (9.1%) were octogenarians (mean age 83.8 +/- 3.0 years). Octogenarians had a higher rate of hypertension and atrial fibrillation compared to younger patients.TECAB was successfully performed without conversion to any larger incisions in octogenarians. Mean operative time (299 +/- 83 minutes vs 281 +/- 89 minutes, P = 0.309) and the rate of multivessel bypass (60.7% vs 58.2%, P = 0.798) were similar between octogenarians and younger patients. New atrial fibrillation was observed more frequently in octogenarians compared to younger patients (35.7% vs 18.6%, P = 0.031). Mean length of hospital stay was similar between the 2 groups (octogenarians: 3.9 +/- 1.8 days vs younger patients: 3.5 +/- 3.0 days, P = 0.475). Twenty-two octogenarians (78.6%) were discharged directly to home. In-hospital mortality was zero in octogenarians. Conclusions: Robotic beating-heartTECAB had favorable results in octogenarians with acceptable morbidity and mortality and excellent short length of stay similar to younger patients.