title: Facilitated endoscopic beating heart coronary artery bypass grafting using a magnetic coupling device.
abstract: BACKGROUND
  Suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. The potential benefits of the endoscopic Magnetic Vascular Positioner device (Ventrica, Inc, Fremont, Calif) to facilitate construction of a coronary anastomosis in a closed chest environment were evaluated.
  
  
  METHODS
  Totally endoscopic coronary artery bypass grafting on the beating heart was performed in 8 foxhound-beagle inbred dogs with the da Vinci telemanipulation system (Intuitive Surgical, Mountain View, Calif). A prototype of the endoscopic Magnetic Vascular Positioner device was used to facilitate construction of the coronary anastomosis. One pair of magnets was inserted in the internal thoracic artery and left anterior descending artery using robotic instruments to guide and place the endoscopic delivery platform. All animals underwent angiography; gross inspection of the anastomotic site was performed after excision of the hearts.
  
  
  RESULTS
  The procedure was accomplished in all animals in 169 minutes (155-190 minutes). Dissection of the left anterior descending coronary artery (6.5 minutes; 1-20 minutes), positioning of the stabilizer (8.5 minutes; 7-16 minutes), placement of occlusion tapes (6 minutes, 3-10 minutes), and arteriotomy 5.5 minutes (3-30 minutes) was achieved without problems. By use of the Magnetic Vascular Positioner device, the anastomosis at the graft site was performed with the graft still in situ. Except for 1 premature deployment, all other deployments were easily accomplished in 3 minutes (1-28 minutes). The following adverse events were encountered: bleeding from the right ventricle caused by occlusion tape (1), anastomotic leakage on reperfusion requiring repair stitches (2), and anastomotic occlusion as a result of thrombus (1). All except 1 animal with a patent graft and anastomosis survived the procedure. The overall patency was 7 of 8.
  
  
  CONCLUSIONS
  The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and a simple yet effective and timesaving technique for anastomotic coupling may facilitate beating heart totally endoscopic coronary artery bypass grafting.
authors.affiliation: Department of Cardiac Surgery, Heartcenter, University of Leipzig, Germany. falv@medizin.uni-leipzig.de
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Hubert
authors.initials: H
authors.lastname: Stein
authors.forename: Stephan
authors.initials: S
authors.lastname: Jacobs
authors.forename: Claudia
authors.initials: C
authors.lastname: Walther
authors.forename: Ardawahn
authors.initials: A
authors.lastname: Rastan
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation; D000818:Animals; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000379:methods; D003327:Coronary Disease / Q000601:surgery*; D004195:Disease Models, Animal; D004285:Dogs; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D008280:Magnetics; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D012371:Robotics; D012680:Sensitivity and Specificity; D013536:Suture Techniques; D014654:Vascular Patency