Update on Less Invasive Cardiac

Surgery at St FrancisRobert Poston, MD

Chairman, Cardiothoracic Surgery

Less invasive

Open surgery

Less invasive

Open surgery

Prior to Feb 2015 Feb 2015 to May 2016

Less Invasive CardiacSurgery at SFMC

Mortality Mortality and Morbidity0

0.5

1

1.5

2

2.5

3

3.5

Outcomes for Heart Bypass at St FrancisFeb ‘15 – March ‘16

(n=204)15%

14.5

14

13.5

13

12.5

12

3%

2.5

2

1.5

1

0.5

0

Observed

Expected

O/E0.88

O/E0.94

stroke deep SWI0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

Highly Morbid ComplicationsAfter Bypass at St. Francis

Feb ‘15 to March ‘16 (n=204)

0% 0%

SFMC Lourdes-Camden STS-National Average

COMMON PRACTICE COMMON COMPLICATION

Ultrasound probe

Ultrasound image

Partial cross clamp

AortaAorta

PROBLEM WITH MULTIVESSEL GRAFTING WITH OFF-PUMP TECHNIQUES

10%

5%

1.8%

1970 1980 1990 2000 2010

INCIDENCE OF STROKE AFTER BYPASS GRAFTING OVER TIME

ON-PUMP CABG MINIMALLY INVASIVE CABG/HYBRID

Conclusions – Stroke after Bypass• Baseline rate of 1.5 – 2.0% due to• Aortic manipulation with atheroembolism• Periods of low blood pressure/poor brain blood flow

• Avoiding stroke after robotic bypass (0 out of 204) due to• No touch surgical technique combined with PCI• Excellent blood pressure during bypass grafting