Establishing the Case for Minimally Invasive, Robotic-Assisted CABG in the Treatment of Multivessel Coronary Artery Disease
AbstractThe purpose of this review is to outline the most common objections about robotic coronary artery bypass graft (CABG), often expressed by cardiac surgeons, cardiologists, and administrators who have little direct knowledge of the procedure. The summarized objections include the high intraoperative costs of robotic versus traditional CABG, a prolonged and difficult learning curve for members of the surgical team, and concerns about compromising graft patency with this technique. Arguments for continued procedure development in robotically assisted CABG are provided.
Bonatti J, Schachner T, Bonaros N, et al. 2008. How to improve performance of robotic totally endoscopic coronary artery bypass grafting. Am J Surg 195:711-6.nBrown P, Kugelmass A, Cohen D, et al. 2008. The frequency and cost of complications associated with coronary artery bypass grafting surgery: results from the United States Medicare program. Ann Thorac Surg 85:1980-6.nCenters for Medicare and Medicaid Services (CMS) [Internet]. 2008. CMS improves patient safety for Medicare and Medicaid by addressing never events. Available from: http://www.cms.hhs.gov/apps/media/fact_sheets.asp'>http://www.cms.hhs.gov/apps/media/fact_sheets.aspnHollenbeak CS, Murphy DM, Koenig S, et al. 2000. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 118:397-402.nKon Z, Reicher B, Brown E, et al. 2008. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared to procedures utilizing only coronary artery bypass grafting. J Thorac Cardiovasc Surg 135:367-75.nOehlinger A, Bonaros N, Schachner T, et al. 2007. Robotic endoscopic left internal mammary artery harvesting: what have we learned after 100 cases? Ann Thorac Surg 83:1030-4.nPoston RS, Prastein D, Gu J, et al. 2004. Virchow's triad, but not use of an aortic connector device, predicts vein graft thrombosis after off-pump bypass. Heart Surg Forum 7:E428-33.nPoston RS, White C, Gu J, et al. 2006. Endothelial injury and acquired aspirin resistance promote regional thrombin formation and early vein graft failure after coronary artery bypass J Thorac Cardiovasc Surg 131:122-30.nPoston RS, Tran R, Collins M, et al. 2008. Comparison of economic and patient outcomes with minimally invasive vs. traditional off-pump CABG techniques. Ann Surg 248:638-46.nSubramanian VA, Patel NU, Patel NC 2005. Robotic assisted multivessel minimally invasive direct coronary artery bypass with port-access stabilization and cardiac positioning: paving the way for outpatient coronary surgery? Ann Thorac Surg 79:1590-6.nSrivastava S, Gadasalli S, Agusala M, et al. 2006. Use of bilateral internal thoracic arteries in CABG through lateral thoracotomy with robotic assistance in 150 patients. Ann Thorac Surg 81:800-6.nSociety of Thoracic Surgeons (STS) [Internet]. 1998. Accountable health care: letting patients lead the way: transforming Medicare for the 21st century. Available from: http://www.sts.org/doc/2809'>www.sts.org/doc/2809n