Effectiveness and safety of total endoscopic left internal mammary artery bypass graft to the left anterior descending artery.
Totally endoscopic coronary artery bypass grafting (CABG) has become a feasible option using robotic technology and remote access perfusion techniques. The aim of this study was to determine the progression of the procedure's performance in the currently largest single-center series of arrested-heart totally endoscopic CABG. From 2001 to 2007, arrested-heart totally endoscopic CABG was performed in 100 patients (median age 59 years, range 46 to 70; 81 men, 19 women). All patients received left internal mammary artery grafts to the left anterior descending artery using the da Vinci Surgical System. Remote-access femoral perfusion and aortic balloon endo-occlusion were used in all patients. The series was divided into 4 phases: phase 1 (patients 1 to 25), phase 2 (patients 26 to 50), phase 3 (patients 51 to 75), and phase 4 (patients 76 to 100). The conversion rates to larger thoracic incisions were 7 of 25 (28%) in phase 1, 2 of 25 (8%) in phase 2, 1 of 25 (4%) in phase 3, and 1 of 25 (4%) in phase 4 (p = 0.018). Operative times and hospital stays decreased significantly with each subsequent phase, and clinical outcome showed corresponding improvements. There was no perioperative mortality. For the whole patient series, 5-year postoperative survival, freedom from angina, and freedom from major adverse cardiac and cerebral events were 100%, 91%, and 89%, respectively. In conclusion, after an initial steep learning curve, completely endoscopic left internal mammary artery-to-left anterior descending CABG can be performed safely, with low conversion rates. The learning curve for operative times and improvements in clinical outcome continued even at 100 procedures.
Bonatti
Johannes
J
Department of Surgery, University of Maryland, Baltimore, MD, USA. jbonatti@smail.umaryland.edu
Schachner
Thomas
T
Bonaros
Nikolaos
N
Oehlinger
Armin
A
Wiedemann
Dominik
D
Ruetzler
Elisabeth
E
Weidinger
Felix
F
Kolbitsch
Christian
C
Feuchtner
Gudrun
G
Zimrin
David
D
Friedrich
Guy
G
Pachinger
Otmar
O
Laufer
Guenther
G
D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D019990:Perioperative Care; D012371:Robotics; D016896:Treatment Outcome