Totally endoscopic sequential arterial coronary artery bypass grafting on the beating heart

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Robotic Surgery

Background:

• Coronary artery disease (CAD) necessitates revascularization when medical management is insufficient.
• Traditional coronary artery bypass grafting (CABG) can be invasive, involving sternotomy.
• Minimally invasive and off-pump techniques aim to reduce surgical trauma and improve patient outcomes.

Observation:

• A 50-year-old male presented with exertional angina due to critical stenosis in the left anterior descending artery and first diagonal branch.
• The patient was evaluated at a thoracic and cardiovascular surgery department in Germany.
• A new version of the da Vinci Surgical System was utilized for the procedure.

Findings:

• Successful sequential grafting of the left internal mammary artery (LIMA) to both the left anterior descending (LAD) artery and the first diagonal branch was achieved.
• The procedure was performed using a totally endoscopic coronary artery bypass grafting (TECAB) technique.
• Grafting was performed off-pump (without cardiopulmonary bypass) on the beating heart.

Implications:

• This represents the first reported case of sequential arterial off-pump grafting of two anterior wall target vessels using a totally endoscopic technique on a beating heart.
• This technique may offer a less invasive alternative for patients requiring bypass of multiple anterior coronary arteries.
• Further research and adoption of this robotic-assisted TECAB approach could expand minimally invasive treatment options for complex CAD.