One hundred sixty-four consecutive beating heart totally endoscopic coronary artery bypass cases without...

Totally endoscopic coronary artery bypass graft (TECABG) surgery has been found to be feasible, but numerous reports associate the procedure with high conversion rates. This report aims to discuss 164 consecutive beating heart TECABG cases without intraoperative conversion to open CABG as well as potential steps to minimize conversion.

Since July 2008, 164 consecutive beating heart TECABG cases were completed without intraoperative conversion. There were 128 male and 36 female patients, with mean age of 62.73 ± 10.51 years (range, 29 to 85). The da Vinci S robotic system with EndoWrist stabilizer was used for the entire procedure through four to five port incisions. Anastomoses were constructed using U-Clips (n = 182) or Flex-A device (n = 54). Two hundred fourteen grafts (88%) were studied in 146 patients (89%) before discharge. Twenty-nine patients (18%) who underwent hybrid coronary revascularization had conventional angiography of bypass grafts whereas 117 patients (71%) had computed tomography angiography to assess gross graft patency.

All patients underwent planned surgical and hybrid revascularization. Single, double, triple, and quadruple vessel beating heart TECABGs were performed in 93, 64, 6, 1 patients, respectively (average 1.48 ± 0.6 grafts per patient). There was no intraoperative conversion to CPB or open CABG technique. There was 1 in-hospital mortality. Two hundred thirteen grafts (99.5%) were found to be patent. Intracoronary shunt was used for 29 anastomoses.

Beating heart TECABG conversion rates decline with experience and thorough preoperative planning as well as with implementation of specific steps to minimize conversion.