Totally endoscopic coronary artery bypass grafting on the arrested heart is a prerequisite for successful totally endoscopic beating heart coronary revascularisation.
Telemanipulators have been introduced into cardiac surgery recently expanding the scope of minimally invasive techniques and enabling endoscopic cardiac surgery. Our aim was to evaluate clinical results of totally endoscopic single vessel bypass grafting on the arrested as well as on the beating heart. Since 1999, 44 totally endoscopic single vessel arterial bypass grafting procedures were performed at our institution. Thirty-eight procedures were performed on the arrested heart (group A), and six such procedures on the beating heart (group B) using the daVinci telemanipulation system. In group A, totally endoscopic coronary artery bypass grafting (TECAB) with left internal thoracic artery (LITA) to left anterior descending artery (LAD) was performed in 33 patients and right internal thoracic artery (RITA) to right coronary artery (RCA) grafting in five cases. The overall conversion rate in group A was 18.4% and dropped down to 5% in the last 20 cases. In group B (n=6), four patients received successful LITA to LAD grafting; two patients (33%) required conversion to minithoracotomy. The first 22 TECAB patients of group A (58%) had control angiography and demonstrated excellent graft patency upon discharge. All grafts in group B showed excellent function on angiographic control as well. The mean procedural time for single vessel TECAB was 4.2+/-0.9h, cardiopulmonary bypass (CPB) time was 136+/-32 min and aortic cross-clamp time amounted to 61+/-16 min. The present data show feasibility of totally endoscopic single arterial grafting on the arrested heart in a reproducible manner, though procedural times were still prolonged due to the difficult handling of the port access system and the complex time consuming endoscopic operation. A low conversion rate was achieved in arrested heart TECAB after a relatively short learning curve and is mandatory for successful totally endoscopic off-pump bypass grafting.
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany. s.dogan@em.uni-frankfurt.de
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Dogan
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Aybek
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Mierdl
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Wimmer-Greinecker