Related Experiment Video
Updated: Jul 11, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Myocardial enzyme release in totally endoscopic coronary artery bypass grafting on the arrested heart
Thomas Schachner1, Nikolaos Bonaros, Elisabeth Ruetzler
1Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. Thomas.Schachner@i-med.ac.at
Insights
Robotic totally endoscopic coronary artery bypass grafting (TECAB) is feasible without sternotomy. Longer operation times in TECAB correlate with increased myocardial enzyme release but do not impact early mortality or left ventricular function.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Robotic totally endoscopic coronary artery bypass grafting (TECAB) offers a sternotomy-free alternative to traditional coronary artery bypass grafting (CABG).
- TECAB currently requires longer cardiopulmonary bypass and aortic occlusion times compared to standard CABG.
- The impact of these extended times on myocardial enzyme release and postoperative outcomes needs investigation.
Purpose of the Study:
- To investigate the relationship between longer operation times in TECAB and myocardial enzyme release.
- To assess the effect of extended TECAB operation times on the postoperative course, including ventilation time, intensive care unit (ICU) stay, and hospital stay.
Main Methods:
- Eighty-five patients underwent robotic TECAB on an arrested heart using the da Vinci system between 2001 and 2006.
- Procedures included various graft configurations, primarily left internal thoracic artery to left anterior descending artery.
- Data collected included operation duration, cardiopulmonary bypass time, aortic endo-occlusion time, and postoperative clinical outcomes.
Main Results:
- Postoperative peak creatine kinase MB and troponin T levels were elevated in a significant portion of patients.
- Increased TECAB duration, cardiopulmonary bypass time, and aortic endo-occlusion time were significantly associated with higher postoperative peak creatine kinase MB levels.
- Elevated enzyme levels correlated with moderately prolonged ICU stay and ventilation time, but not with sex, age, or EuroSCORE.
Conclusions:
- Myocardial protection is achievable during arrested heart TECAB procedures.
- While increased myocardial enzyme release is detectable and linked to longer ICU and ventilation times, it does not lead to early mortality or reduced left ventricular ejection fraction.
Objective:
Robotic totally endoscopic coronary artery bypass grafting enables coronary artery bypass grafting without sternotomy or thoracotomy. However, longer cardiopulmonary bypass and aortic endo-occlusion times are currently required compared with those of standard coronary artery bypass grafting operations. We investigated whether longer operation times affect the myocardial enzyme release and the postoperative course.
Methods:
From 2001 through 2006, 85 patients with a median age of 58 years (range, 31-76 years) underwent totally endoscopic coronary artery bypass grafting on the arrested heart by using the da Vinci telemanipulator and remote access perfusion through the femoral vessels (Estech or Heartport). The operations involved the left internal thoracic artery-left anterior descending coronary artery or diagonal branch (n = 74); right internal thoracic artery-right coronary artery (n = 2); double-vessel left internal thoracic artery-obtuse marginal branch/circumflex artery and right internal thoracic artery-left anterior descending coronary artery (n = 8); and double-vessel left internal thoracic artery-left anterior descending coronary artery and saphenous vein graft-right coronary artery (n = 1). Totally endoscopic coronary artery bypass grafting duration was 254 minutes (range, 178-710 minutes), cardiopulmonary bypass time was 114 minutes (range, 57-428 minutes), and aortic endo-occlusion time was 65 minutes (range, 28-230 minutes).
Results:
The postoperative ventilation time was 8 hours (range, 0-278 hours), and the intensive care unit stay was 20 hours (range, 11-389 hours). The postoperative stay at our department was 6 days (range, 4-22 days), and we observed no hospital deaths in this series. Forty-five percent of the patients had an increased postoperative peak creatine kinase MB level, and 75% had an increased troponin T level. Postoperative peak creatine kinase MB levels significantly increased with totally endoscopic coronary artery bypass grafting duration (r = 0.588, P < .001), cardiopulmonary bypass time (r = 0.521, P < .001), and aortic endo-occlusion time (r = 0.400, P < .001) and translated into moderately prolonged intensive care unit stay (r = 0.432, P < .001) and ventilation time (r = 0.517, P < .001). Creatine kinase MB levels were not associated with sex, age, or EuroSCORE. The postoperative left ventricular ejection fraction did not differ significantly from the preoperative left ventricular ejection fraction.
Conclusions:
Myocardial protection can be established in arrested heart totally endoscopic coronary artery bypass grafting operations. An influence of increased myocardial enzyme release on postoperative ventilation time and intensive care unit stay is detectable but does not translate into an early mortality or a decrease in left ventricular ejection fraction.
