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Hybrid coronary revascularization by endoscopic robotic coronary artery bypass grafting on beating heart and stent
Changqing Gao1, Ming Yang, Yang Wu
1Department of Cardiovascular Surgery, PLA General Hospital, PLA Institute of Cardiac Surgery, Beijing, China. gaochq301@yahoo.com
Insights
This study shows that hybrid coronary revascularization, combining robotic bypass surgery on a beating heart with stent placement, is a safe and feasible approach for treating multivessel coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Background:
- Hybrid revascularization combines minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for multivessel coronary artery disease (CAD).
- Endoscopic robotic coronary artery bypass grafting on a beating heart is rarely reported.
- Assessing hybrid revascularization using endoscopic robotic bypass and percutaneous coronary intervention in a staged approach is the study's focus.
Purpose of the Study:
- To evaluate the feasibility of hybrid coronary revascularization.
- To assess endoscopic robotic coronary artery bypass grafting on a beating heart combined with percutaneous coronary intervention.
- To investigate a staged approach for treating multivessel coronary artery disease.
Main Methods:
- Forty-two patients underwent robotic coronary artery bypass grafting on the beating heart.
- Ten patients received stent placement after robotic left internal mammary artery (LIMA) to left anterior descending (LAD) artery anastomosis.
- Percutaneous coronary intervention for non-LAD targets was performed 4-5 days post-surgery.
Main Results:
- All 10 patients in the hybrid group completed off-pump robotic bypass surgery and stent placement.
- The staged hybrid approach was performed without any complications.
- Angiographic assessment confirmed the patency of all LIMA-LAD grafts.
Conclusions:
- Hybrid coronary revascularization using endoscopic robotic bypass grafting on a beating heart and subsequent stenting is feasible.
- This integrated, staged approach offers a viable option for patients with multivessel CAD.
- Preliminary findings support the safety and efficacy of this hybrid strategy.
Background:
Hybrid revascularization has been used in minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for multivessel coronary artery disease (CAD). Very few endoscopic robotic coronary bypasses on the beating heart have been reported. The aim of this study was to assess hybrid revascularization by endoscopic robotic coronary artery bypass on the beating heart with percutaneous coronary intervention in a staged approach.
Methods:
Forty-two patients underwent selective robotic coronary artery bypass grafting on the beating heart. Ten patients with right coronary artery or circumflex coronary stenosis underwent stent placement after robotic left internal mammary artery (LIMA) anastomosis to the left anterior descending (LAD) artery surgery in a separate session. The average age of the patients was 62.3 +/- 12.1 years old. Coronary arteriography showed significant stenosis or total occlusion of the LAD in all patients and significant stenosis in the right coronary or circumflex arteries. The LIMA was harvested by the da Vinci S robotic surgical system (Intuitive Surgical, Sunnyvale, CA) and manually anastomosed to the LAD off-pump in 6 patients, and by totally endoscopic bypass on the beating heart in 4 patients. Percutaneous coronary intervention with placement of a stent to stenotic non-LAD targets was performed 4 to 5 days after operation. All LIMA-LAD grafts were assessed angiographically.
Results:
All 10 patients had off-pump robotic bypass surgery and stent placement using a staged approach without complications.
Conclusions:
Our preliminary study shows that hybrid coronary revascularization by endoscopic robotic coronary artery bypass grafting on a beating heart and subsequent stent placement is a feasible integrated approach for patients with multivessel CAD.
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