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[Robotically assisted coronary artery bypass grafting on beating heart]
Chang-qing Gao1, Yang Wu, Ming Yang
1Department of Cardiovascular Surgery, People's Liberation Army General Hospital, Beijing 100853, China. gaochq301@yahoo.com
Insights
Robotically assisted coronary artery bypass grafting (RACABG) on beating heart is a safe and effective procedure. This advanced technique shows excellent graft patency and outcomes for single and multi-vessel coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Robotic Surgery
Context:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Minimally invasive approaches aim to reduce surgical trauma and improve recovery.
- Robotic systems offer enhanced precision and dexterity for complex surgical tasks.
Purpose:
- To evaluate the safety and efficacy of robotically assisted coronary artery bypass grafting (RACABG) on a beating heart.
- To assess graft flow and patency rates following RACABG.
- To determine the feasibility of RACABG for both single and multi-vessel coronary artery disease.
Summary:
- 105 patients underwent RACABG on a beating heart using the da Vinci S system via minithoracotomy.
- The procedure involved harvesting internal mammary arteries and anastomosing them to coronary targets.
- Mean graft flow was 21 ± 13 ml/min, with all grafts patent on follow-up (mean 30 ± 12 months).
- No deaths, strokes, or reinterventions occurred; patients were discharged without complications.
Impact:
- RACABG on a beating heart is a safe and advanced revascularization strategy.
- This technique is suitable for patients with single and multi-vessel coronary artery disease.
- The da Vinci S system facilitates precise execution of complex bypass procedures.
Objectives:
To analyze the safety and efficiency of robotically assisted coronary artery bypass grafting (RACABG) on beating heart using da Vinci S system.
Methods:
From January 2007 to March 2011, 105 patients underwent RACABG on beating heart through minithoracotomy. There were 77 male and 28 female patients, aged from 33 to 77 years with a mean of (59 ± 10) years. After establishment of single left lung ventilation, the 3 trocars of da Vinci system were inserted into the left hemithorax, and robotic system was used to harvest the left internal mammary artery (LIMA) and/or right internal mammary artery (RIMA) from the subclavian vein to the internal mammary artery (IMA) bifurcation with skeletonized technique. After positioning the stabilizer, the LIMA was anastomosed manually to the left anterior descending or diagonal branch sequentially on beating heart through left minithoracotomy. The graft flow was evaluated by the Doppler flow meter after anastomosis was completed, and the graft patency was also evaluated by CT angiography or arteriography after surgery.
Results:
All patients had successful RACABG on the beating heart, and the mean graft flow was (21 ± 13) ml/min. One patient suffered from cardiac arrest after the first postoperative day, but he recovered soon and CT angiography showed that graft was patent. One patient with preoperative stroke had postoperative pulmonary infection, and was discharged after treatment. After 4 to 5 days, 4 patients received stent placement in right coronary artery or circumflex coronary in distinct hybrid session. There were no deaths or stroke or reintervention. All patients were discharged without complications and followed up. CTA or angiography revealed patent grafts in all patients, and the mean time of follow-up was (30 ± 12) months.
Conclusions:
Robotically assisted coronary artery bypass grafting on beating heart can be performed safely using da Vinci S system. It is a new advanced approach of revascularization not only for patients with single vessel but with multi-vessel lesions as well.
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