Robotic-Assisted Off-Pump Sole Transmyocardial Revascularization: Case Report

Authors

  • Kurt E. Wehberg
  • James C. Todd
  • J. Stephens Julian
  • Nicholas L. Ogburn
  • Edward H. Klopp
  • Michael P. Buchness

DOI:

https://doi.org/10.1532/HSF98.20033006

Abstract

Thoracoscopic transmyocardial revascularization (TMR) has been recently demonstrated. We report 2 patients who underwent robotic-assisted thoracoscopic off-pump sole TMR. A 2-inch minimally invasive left anterolateral thoracotomy was made. Pericardial dissection and TMR were performed in an open manner facilitated by improved visualization using voice-activated robotic-assisted thoracoscopy (AESOP, Computer Motion, Santa Barbara, CA, USA). Patient 1 was a 73-year-old man with class IV angina who underwent coronary artery bypass grafting (CABG) ´ 4 20 years earlier. Cardiac catheterization revealed occluded grafts, no native vessels that were amenable to percutaneous coronary intervention (PCI) or CABG, and an ejection fraction (EF) of 55%. Forty-five Holmium-Yag (CardioGenesis, Foothill Ranch, CA, USA) laser channels were created in the left ventricular wall. Total operating room (OR) time was 93 minutes. He was extubated in the OR and was discharged from the intensive care unit (ICU) in 18 hours and from the hospital on the second postoperative day angina free. Patient 2 was a 48-year-old woman with class IV angina who had undergone CABG ´ 6 3 years earlier but who had persistent chest pain following the revascularization. After 12 cardiac readmissions in 1 year, including multiple PCIs, a recent catheterization showed patent grafts except for the circumflex branches and an EF of 45%. Forty-six channels were created in the left ventricle in a similar fashion. OR time was 62 minutes, ICU time was 20 hours, and postoperative length of stay was 2 days. The patient also was angina free at discharge. This report suggests that robotic-assisted thoracoscopy provides enhanced visualization and efficient delivery during off-pump sole TMR, and this technique may be associated with reduced operative times and improved recovery time.

References

Milano A, Pietrabissa A, Bortolotti U. 1998. Thoracoscopic transmyocardial revascularization. Ann Thorac Surg 65(5):1510-1.nMilano A, Pratali S, DeCarlo M, Pietrabissa A, Bortolotti U. 1998. Transmyocardial holmium laser revascularization: feasibility of a thoracoscopic approach. Euro J Cardiothorac Surg 14(suppl 1):S105-10.nWehberg KE, Julian JS, Todd JC, Ogburn NL, Klopp EH, Buchness ML. 2003. Improved outcomes with CABG plus TMR. Heart Surg Forum 6(5):1-3.nWehberg KE, Krasna MJ. 2001. Thoracoscopic cardiac surgery. In: Karl Zucker, editor. Surgical laparoscopy. 2nd ed. Baltimore, MD, USA: Lip pincott, Williams & Wilkins. p 701-6.nAllen KB, Dowling RD, Fudge TL, et al. 1999. Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med 341:1029-36.ndeGuzman BJ, Lautz DB, Chen FY, Laurence RG, Ahmad RM, Horvath KA. 1997. Thoracoscopic transmyocardial laser revascularization. Ann Thorac Surg 64(1):171-4.nHorvath KA. 1998. Thoracoscopic transmyocardial laser revascularization. Ann Thorac Surg 65(5):1439-41.n

Published

2005-01-04

How to Cite

Wehberg, K. E., Todd, J. C., Julian, J. S., Ogburn, N. L., Klopp, E. H., & Buchness, M. P. (2005). Robotic-Assisted Off-Pump Sole Transmyocardial Revascularization: Case Report. The Heart Surgery Forum, 7(2), E130-E131. https://doi.org/10.1532/HSF98.20033006

Issue

Section

Article