Robotic-assisted off-pump sole transmyocardial revascularization: case report

Area of Science:

• Minimally Invasive Cardiac Surgery
• Robotic-Assisted Thoracoscopy
• Transmyocardial Revascularization (TMR)

Background:

• Transmyocardial revascularization (TMR) is a recently developed procedure for myocardial revascularization.
• Two patients with severe angina, who had previously undergone multiple coronary artery bypass grafting (CABG) procedures and percutaneous coronary interventions (PCI) with limited success, were treated with robotic-assisted thoracoscopic off-pump sole TMR.

Observation:

• A minimally invasive left anterolateral thoracotomy was performed.
• Voice-activated robotic-assisted thoracoscopy (AESOP) provided enhanced visualization for pericardial dissection and TMR.
• Holmium-Yag laser channels were created in the left ventricular wall for both patients.

Findings:

• Patient 1: 73-year-old male, Class IV angina, occluded grafts, ejection fraction (EF) 55%. Underwent 45 laser channels, 93-minute OR time, extubated in OR, discharged ICU in 18 hours, hospital on postoperative day 2, angina-free.
• Patient 2: 48-year-old female, Class IV angina, patent grafts except circumflex, EF 45%. Underwent 46 laser channels, 62-minute OR time, 20-hour ICU stay, 2-day postoperative length of stay, angina-free at discharge.
• Robotic-assisted TMR was performed off-pump and solely as a revascularization strategy.

Implications:

• Robotic-assisted thoracoscopy enhances visualization and efficiency for off-pump TMR.
• This technique may lead to reduced operative times and improved patient recovery.
• The findings suggest potential for robotic TMR as an effective treatment option for refractory angina.