Robotic Totally Endoscopic Double-Vessel Bypass Grafting: A Further Step Toward Closed-Chest Surgical Treatment of Multivessel Coronary Artery Disease
Background. After the introduction of robotic technology into the heart surgery armamentarium the performance of totally endoscopic coronary artery bypass grafting (TECAB) has become a reality. During the first years of development, the majority of TECAB cases were restricted to single-vessel disease, and the development of multivessel procedures is desirable. We report on a preliminary series of totally endoscopic double-vessel coronary artery bypass grafting.
Methods. From 2004 to 2006, 10 patients underwent endoscopic placement of the right internal mammary artery (RIMA) to the left anterior descending artery (LAD) in combination with left internal mammary artery (LIMA) grafting to an obtuse marginal (OM) branch. Indications for the operation were isolated left main disease or left main equivalents. All procedures were performed using the daVinci telemanipulation system, remote-access perfusion, and aortic balloon endo-occlusion.
Results. Seven of the 10 interventions were completed endoscopically, and 3 patients were converted to sternotomy. RIMA takedown time was 40 minutes (range, 29-49 minutes); LIMA takedown time was 38 minutes (range, 29-48 minutes). LAD and OM anastomotic times were 23 minutes (range, 14-53 minutes) and 38 minutes (range, 29-48 minutes), respectively. Total TECAB time was 477 minutes (range, 385-545 minutes). Median ventilation time was 15 hours (range, 6-40 hours), median intensive care unit stay was 41 hours (range, 15-141 hours), and patients were discharged after a median of 7 days (range, 5-22 days). No major adverse cardiac or cerebrovascular events occurred during short-term follow-up.
Conclusion. Totally endoscopic double-vessel coronary artery bypass grafting on the arrested heart is a reproducible procedure. This intervention offers maximal preservation of patient integrity, but the long operative times need to be investigated.
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