Date of Award

Spring 2021

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Zachary Weik, MHS, PA-C

Abstract

Introduction: Coronary artery disease (CAD) is the most common heart disease in the United States, oftentimes leading to complications such as myocardial infarction and death. Coronary artery bypass grafting (CABG) is the preferred surgical treatment to extend the lives of stable CAD patients. Although conventional CABG (C-CABG) remains the surgical treatment of choice, less invasive techniques exist, such as robotic-assisted CABG (R-CABG). While it has been found that R-CABG has multiple benefits, little is known about the mortality comparisons between the two techniques. This paper hopes to explore: In the surgical treatment of coronary artery disease in adult patients (P), do robotic-assisted surgical techniques (I) result in less overall mortality (O) compared to conventional bypass grafting surgery (C)?

Methods: A literature search was conducted using PubMed and EBSCOhost Academic Search Ultimate in November 2019. A total of five articles were selected based on relevance to the topic, surgical techniques used, and the outcomes that were measured.

Results: Evidence demonstrated that R-CABG was comparable to conventional surgical techniques in regard to safety and efficacy. However, the comprehensive evidence collected by these studies was not convincing enough to conclude that R-CABG surgical techniques resulted in less overall mortality. One study found that while robotic-assisted techniques were safe, it did not significantly decrease cardiovascular events or mortality in CAD patients. Of the remaining studies, only one demonstrated statistically significant results to provide evidence that robotically-assisted technique results in an overall decrease in mortality.

Discussion: A majority of the studies found that mortality outcomes for R-CABG was comparable or slightly superior to C-CABG. Just one study had data that was statistically significant in favor of R-CABG both perioperative mortality and long-term survival. Most studies had stringent inclusion criteria to ensure appropriate subjects. However, not all studies measured long-term mortality. All studies had limitations such as cohort, observational study designs, unmatched groups, and selection bias.

Conclusion: The expansion of R-CABG for CAD patients shows promise, as its use has been found to be safe, effective, and comparable to C-CABG outcomes. While some statistical significance has been found in its favor over conventional techniques, future studies should look to improve the validity of these findings through randomized trials that better assess lifelong mortality. Given these findings, more data is needed to accurately distinguish a preference for R-CABG in clinical practice.

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FinalCapstoneRyanUle.mp4 (11813 kB)
Poster Presentation

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Comparing Mortality of Robotic-Assisted Coronary Artery Bypass Grafting with Conventional Surgery in Coronary Artery Disease Patients

Introduction: Coronary artery disease (CAD) is the most common heart disease in the United States, oftentimes leading to complications such as myocardial infarction and death. Coronary artery bypass grafting (CABG) is the preferred surgical treatment to extend the lives of stable CAD patients. Although conventional CABG (C-CABG) remains the surgical treatment of choice, less invasive techniques exist, such as robotic-assisted CABG (R-CABG). While it has been found that R-CABG has multiple benefits, little is known about the mortality comparisons between the two techniques. This paper hopes to explore: In the surgical treatment of coronary artery disease in adult patients (P), do robotic-assisted surgical techniques (I) result in less overall mortality (O) compared to conventional bypass grafting surgery (C)?

Methods: A literature search was conducted using PubMed and EBSCOhost Academic Search Ultimate in November 2019. A total of five articles were selected based on relevance to the topic, surgical techniques used, and the outcomes that were measured.

Results: Evidence demonstrated that R-CABG was comparable to conventional surgical techniques in regard to safety and efficacy. However, the comprehensive evidence collected by these studies was not convincing enough to conclude that R-CABG surgical techniques resulted in less overall mortality. One study found that while robotic-assisted techniques were safe, it did not significantly decrease cardiovascular events or mortality in CAD patients. Of the remaining studies, only one demonstrated statistically significant results to provide evidence that robotically-assisted technique results in an overall decrease in mortality.

Discussion: A majority of the studies found that mortality outcomes for R-CABG was comparable or slightly superior to C-CABG. Just one study had data that was statistically significant in favor of R-CABG both perioperative mortality and long-term survival. Most studies had stringent inclusion criteria to ensure appropriate subjects. However, not all studies measured long-term mortality. All studies had limitations such as cohort, observational study designs, unmatched groups, and selection bias.

Conclusion: The expansion of R-CABG for CAD patients shows promise, as its use has been found to be safe, effective, and comparable to C-CABG outcomes. While some statistical significance has been found in its favor over conventional techniques, future studies should look to improve the validity of these findings through randomized trials that better assess lifelong mortality. Given these findings, more data is needed to accurately distinguish a preference for R-CABG in clinical practice.