Is an Intraaortic Balloon Pump a Contraindication to Robotic Totally Endoscopic Coronary Artery Bypass?

Authors

  • Zachary N. Kon
  • Eric Lehr
  • Patrick Odonkor
  • Molly Fitzpatrick
  • David Zimrin
  • Bartley Griffith
  • Johannes Bonatti

DOI:

https://doi.org/10.1532/HSF98.20101152

Abstract

Background: The success of robotic totally endoscopic coronary artery bypass (TECAB) in recent years has led to the expansion of the procedure to patients with more severe disease. Outcomes with these patients have not yet been well characterized, and no reports on TECAB performed in patients with a preoperatively placed intraaortic balloon pump (IABP) are available. We present our initial experience with this patient population.

Patients and Methods: We evaluated 5 patients with unstable angina or impaired left ventricular function requiring a preoperatively placed IABP who underwent TECAB using the daVinci telemanipulation system. Procedures were performed either on the beating heart using an endostabilizer (n = 2) or on the arrested heart using remote access perfusion and aortic balloon endoocclusion (n = 3). The median patient age was 67 years (range, 41-73 years), with a median preoperative ejection fraction of 43% (range, 26%-58%) and median EuroSCORE of 5 (range, 3-8).

Results: There were no major intraoperative technical issues. The median length of stay in the hospital and intensive care unit was 8 days (range, 5-13 days) and 66 hours (range, 41-142 hours), respectively. There were no intraoperative or 30-day mortalities.

Conclusions: This early experience suggests that TECAB is feasible in patients with a preoperatively placed IABP. Both the beating heart and arrested heart versions can be used in this patient population, further broadening the spectrum of applicability of this procedure.

References

Argenziano M, Katz M, Bonatti J, et al. 2006. Results of the prospective multicenter trial of robotically assisted totally endoscopic coronary artery bypass grafting. Ann Thorac Surg 81:1666-74.nBonatti J, Schachner T, Bonaros N, et al. 2006. Technical challenges in totally endoscopic robotic coronary artery bypass grafting. J Thorac Cardiovasc Surg 131:146-53.nBonatti J, Schachner T, Bonaros N, et al. 2009. Effectiveness and safety of total endoscopic left internal mammary artery bypass graft to the left anterior descending artery. Am J Cardiol 104:1684-8.nBonatti J, Schachner T, Wiedemann D, et al. 2010. Factors influencing blood transfusion requirements in robotic totally endoscopic coronary artery bypass grafting on the arrested heart. Eur J Cardiothorac Surg 20 July 2010. Epub ahead of print.nBrown JR, Cochran RP, Leavitt BJ, et al. 2007. Multivariable prediction of renal insufficiency developing after cardiac surgery. Circulation 116(11 Suppl):I139-43.nde Cannière D, Wimmer-Greinecker G, Cichon R, et al. 2007. Feasibility, safety, and efficacy of totally endoscopic coronary artery bypass grafting: multicenter European experience. J Thorac Cardiovasc Surg 134:710-6.nDogan S, Aybek T, Andressen E, et al. 2002. Totally endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: report of forty-five cases. J Thorac Cardiovasc Surg 123:1125-31.nFalk V, Diegeler A, Walther T, et al. 2000. Total endoscopic computer enhanced coronary artery bypass grafting. Eur J Cardiothorac Surg 17:38-45.nPrifti E, Bonacchi M, Giunti G, et al. 2000. Does on-pump/beating-heart coronary artery bypass grafting offer better outcome in end-stage coronary artery disease patients? J Card Surg 15:403-10.nShahian DM, O'Brien SM, Filardo G, et al. 2009. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1—coronary artery bypass grafting surgery. Ann Thorac Surg 88(1 Suppl):S2-22.nShroyer AL, Plomondon ME, Grover FL, Edwards FH. 1999. The 1996 coronary artery bypass risk model: the Society of Thoracic Surgeons Adult Cardiac National Database. Ann Thorac Surg 67:1205-8.nSrivastava S, Gadasalli S, Agusala M, et al. 2010. Beating heart totally endoscopic coronary artery bypass. Ann Thorac Surg 89:1873-9.n

Published

2010-12-17

How to Cite

Kon, Z. N., Lehr, E., Odonkor, P., Fitzpatrick, M., Zimrin, D., Griffith, B., & Bonatti, J. (2010). Is an Intraaortic Balloon Pump a Contraindication to Robotic Totally Endoscopic Coronary Artery Bypass?. The Heart Surgery Forum, 13(6), E399-E401. https://doi.org/10.1532/HSF98.20101152

Issue

Section

Article