Integrated coronary revascularization: percutaneous coronary intervention plus robotic totally endoscopic coronary artery bypass.
BACKGROUND
Robotic totally endoscopic coronary artery bypass (TECAB) of the left anterior descending artery (LAD) coupled with percutaneous coronary intervention (PCI) of a second coronary artery has been investigated in patients with multivessel disease to provide a minimally invasive therapeutic option.


RESULTS
TECAB of the LAD was performed using the left internal mammary artery (LIMA). A second lesion was treated with PCI before surgery, simultaneously, or after surgery. Three-month angiographic follow-up was performed in all patients and was subject to independent review. A total of 27 patients requiring double vessel revascularization were treated at 7 centers. Eleven patients underwent PCI before surgery, 12 patients underwent PCI after surgery, and 4 patients underwent simultaneous surgical and percutaneous intervention. Ten patients (37%) were treated with bare metal stents, whereas 17 patients (63%) were treated with drug-eluting stents. Postoperative angiographic evaluation demonstrated an overall LIMA anastomotic patency of 96.3% and PCI vessel patency of 66.7%. There were no deaths or strokes. One patient experienced a perioperative myocardial infarction. Eight of 27 patients (29.6%) required reintervention, 1 LIMA anastomotic stenosis (3.7%), 3 after bare metal stent (30%), and 4 after drug-eluting stent placement (23.5%).


CONCLUSIONS
Integrated revascularization treatment plans provide minimally invasive options for patients with multivessel coronary artery disease. This approach may be accomplished with no mortality, low perioperative morbidity, and excellent angiographic LIMA patency. The reintervention rate after PCI in this series was higher than that reported elsewhere and should be investigated further. The choice of suitable vessel, type of stent and timing of the treatment must be carefully considered before implementing this hybrid strategy.
Katz
Marc R
MR
Cardiac & Thoracic Surgical Associates (M.R.K.), Richmond, VA, USA. mkatz@newheartsurgery.com
Van Praet
Frank
F
de Canniere
Didier
D
Murphy
Douglas
D
Siwek
Leland
L
Seshadri-Kreaden
Usha
U
Friedrich
Guy
G
Bonatti
Johannes
J
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology; D003331:Coronary Vessels / Q000601:surgery; D004343:Drug Implants; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012086:Reoperation; D012371:Robotics; D015607:Stents; D014654:Vascular Patency
D004343:Drug Implants