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Computer-assisted endoscopic coronary artery bypass anastomoses: a chronic animal study
E R Stephenson1, C T Ducko, S Sankholkar
1Department of Surgery, The Milton S. Hershey Medical Center, Penn State Geisinger Health System, Hershey 17033, USA.
Insights
Robotically-assisted microsurgery enables endoscopic coronary artery bypass grafting (ECABG) in a chronic animal model. This innovative technique demonstrated feasibility and excellent long-term graft patency, paving the way for minimally invasive cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Robotic Surgery
Background:
- Traditional instruments limit endoscopic coronary artery bypass grafting (ECABG).
- A novel approach is needed to achieve minimally invasive ECABG.
- Robotic assistance offers potential for complex endoscopic procedures.
Purpose of the Study:
- To determine the feasibility of robotically-assisted microsurgical system for ECABG.
- To evaluate ECABG in a chronic animal model.
- To assess graft patency and hemodynamic function post-procedure.
Main Methods:
- Nine calves underwent cardiopulmonary bypass.
- Left internal mammary artery (LIMA) harvested for grafting.
- Subxiphoid endoscopic ports and robotic system used for ECABG to the left anterior descending coronary artery.
Main Results:
- Acute graft patency was 89% (8/9).
- Mean LIMA graft flow (LIMAQ) was consistent acutely and chronically.
- Survivors showed 100% angiographic and histologic graft patency at 1 month.
Conclusions:
- Endoscopic coronary artery bypass grafting (ECABG) is feasible in a chronic animal model.
- Robotically-assisted microsurgery provides excellent results for ECABG.
- This technique holds promise for future minimally invasive cardiac surgery.
Background:
With traditional instruments, endoscopic coronary artery bypass grafting (ECABG) has not been possible. This study was designed to determine the feasibility of using a robotically-assisted microsurgical system to perform ECABG in a chronic animal model.
Methods:
Nine calves were placed on cardiopulmonary bypass after harvesting the left internal mammary artery (LIMA). Subxiphoid endoscopic ports (2 instrument, 1 camera) were placed, and a robotic system was used to perform ECABG between the LIMA and left anterior descending coronary artery. LIMA graft flow (LIMAQ) was measured. Animals were sacrificed at 1 month, and hearts underwent angiographic and histologic analyses.
Results:
Acute graft patency was 89% (8/9). Two animals died suddenly within the first 48 hours. There was no significant difference in mean acute and chronic (n = 6) LIMAQ (40.9+/-4.7 and 38.5+/-5.0 ml/min, respectively). Survivors had an angiographic patency rate of 100% (6/6), confirmed by histology.
Conclusions:
This study shows that ECABG is feasible in a chronic animal model with excellent results.