Conversion of Endoscopic, Robotically Assisted Coronary Bypass: Incidence, Risk Factors, and Outcome

  • Thomas A. Vassiliades, Jr.


Background: The clinical and financial consequences of conversion from endoscopic (robotically assisted) atraumatic coronary artery bypass (EndoACAB) to sternotomy (converted EndoACAB) have not been previously reported. This study sought to identify the incidence, causes, predictive factors, and adverse consequences of converted EndoACAB.

Methods: Between June 1996 and June 2003, 509 patients underwent EndoACAB, and an additional 20 EndoACAB patients underwent converted EndoACAB. Data from the patients requiring conversion to sternotomy were retrospectively reviewed using multivariate regression and computer matched with data from a cohort of patients who underwent primary sternotomy (SternCAB).

Results: The overall rate of conversion was 3.8% (20/509). Causes were: inability to expose the target vessel(s) (9), unsuitable internal mammary artery (7), intrathoracic bleeding (2), and hemodynamic instability (2). There were no statistical differences in mortality or major morbidity between converted EndoACAB patients versus the computer-matched SternCAB patients (P = not significant). Hospital costs for the converted EndoACAB patients were higher than for the successful EndoACAB patients, but not higher than the computer-matched SternCAB patients.

Conclusions: The incidence of conversion of EndoACAB patients to sternotomy was low and often occurred under elective circumstances. The clinical and economic consequences of conversion were minimal.


Bucerius J, Metz S, Walther T, et al. 2002. Endoscopic internal thoracic artery dissection leads to significant reduction of pain after minimally invasive direct coronary artery bypass graft surgery. Ann Thorac Surg 73:1180-4.\nCalafiore A, Giammarco GD, Teodori G, et al. 1996. Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg 61:1658-63.\nDetter C, Reichenspurner H, Boehm D, et al. 2001. Single vessel revascularization with beating heart techniques--minithoracotomy or sternotomy? Eur J Cardiothorac Surg 19:464-70.\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.\nKappert U, Schneider J, Cichon R, et al. 2001. Development of robotic enhanced endoscopic surgery for the treatment of coronary artery disease. Circulation 104:102-7.\nVassiliades T. 2001. Atraumatic coronary artery bypass: technique and outcomes. Heart Surg Forum 4:331-4.\nVassiliades T. 2003. Multi-vessel, all-arterial, off-pump surgical revascularization without disruption of the thoracic skeleton. Heart Surg Forum. In press.\n
How to Cite
Vassiliades, Jr., T. A. (2005). Conversion of Endoscopic, Robotically Assisted Coronary Bypass: Incidence, Risk Factors, and Outcome. The Heart Surgery Forum, 7(1), E19-E21.