title: Feasibility, safety, and efficacy of totally endoscopic coronary artery bypass grafting: multicenter European experience.
abstract: OBJECTIVE
  The invention of robotic systems has begun a new era of endoscopic cardiac surgery. Reports on totally endoscopic coronary artery bypass grafting are limited, however, and data regarding feasibility, safety, and efficacy are needed to determine this technique's position in the therapeutic armamentarium. This study describes the largest multicenter experience in the literature with robotic totally endoscopic coronary artery bypass grafting specifically addressing procedural feasibility, safety, and efficacy.
  
  
  METHODS
  Between September 1998 and November 2002, a total of 228 patients with coronary artery disease were scheduled for totally endoscopic coronary artery bypass grafting with the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, Calif.) at five European institutions. Patients underwent totally endoscopic coronary artery bypass grafting with either an on-pump (group A, n = 117) or an off-pump approach (group B, n = 111). Patients underwent postoperative angiography or stress electrocardiography and were followed up for 6 months.
  
  
  RESULTS
  Procedural feasibility was demonstrated through the completion of 164 successful totally endoscopic cases. Sixty-four patients (group C, 28%) had conversion to nonrobotic procedures. Conversion rates decreased with time. The overall procedural efficacy, as defined by angiographic patency or lack of ischemic signs on stress electrocardiography, was 97%. The incidence of major adverse cardiac events within 6 months was 5%.
  
  
  CONCLUSIONS
  Both on- and off-pump totally endoscopic coronary artery bypass grafting are feasible, with a conversion rate that diminishes with increasing experience. Conversion does not adversely affect outcome and thus constitutes a safe alternative. Although target vessel reintervention may be slightly higher than that reported for open coronary artery bypass grafting, graft patency and major adverse cardiac events for both approaches are comparable to those reported in the Society of Thoracic Surgeons database, demonstrating the safety and efficacy of the totally endoscopic coronary artery bypass grafting procedure.
authors.affiliation: Department of Cardiac Surgery at Erasme University Hospital, Brussels, Belgium. didier.decanniere@ulb.ac.be
authors.forename: Didier
authors.initials: D
authors.lastname: de Cannière
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Romuald
authors.initials: R
authors.lastname: Cichon
authors.forename: Vassilios
authors.initials: V
authors.lastname: Gulielmos
authors.forename: Frank
authors.initials: F
authors.lastname: Van Praet
authors.forename: Usha
authors.initials: U
authors.lastname: Seshadri-Kreaden
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D004724:Endoscopy; D005060:Europe; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D012371:Robotics; D012449:Safety