title: Is an intraaortic balloon pump a contraindication to robotic totally endoscopic coronary artery bypass?
abstract: BACKGROUND
  The success of robotic totally endoscopic coronary artery bypass (TECAB) in recent years has led to the expansion of the procedure to patients with more severe disease. Outcomes with these patients have not yet been well characterized, and no reports on TECAB performed in patients with a preoperatively placed intraaortic balloon pump (IABP) are available. We present our initial experience with this patient population.
  
  
  METHODS
  We evaluated 5 patients with unstable angina or impaired left ventricular function requiring a preoperatively placed IABP who underwent TECAB using the daVinci telemanipulation system. Procedures were performed either on the beating heart using an endostabilizer (n = 2) or on the arrested heart using remote access perfusion and aortic balloon endoocclusion (n = 3). The median patient age was 67 years (range, 41-73 years), with a median preoperative ejection fraction of 43% (range, 26%-58%) and median EuroSCORE of 5 (range, 3-8).
  
  
  RESULTS
  There were no major intraoperative technical issues. The median length of stay in the hospital and intensive care unit was 8 days (range, 5-13 days) and 66 hours (range, 41-142 hours), respectively. There were no intraoperative or 30-day mortalities.
  
  
  CONCLUSIONS
  This early experience suggests that TECAB is feasible in patients with a preoperatively placed IABP. Both the beating heart and arrested heart versions can be used in this patient population, further broadening the spectrum of applicability of this procedure.
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
authors.forename: Eric
authors.initials: E
authors.lastname: Lehr
authors.forename: Patrick
authors.initials: P
authors.lastname: Odonkor
authors.forename: Molly
authors.initials: M
authors.lastname: Fitzpatrick
authors.forename: David
authors.initials: D
authors.lastname: Zimrin
authors.forename: Bartley
authors.initials: B
authors.lastname: Griffith
authors.forename: Johannes
authors.initials: J
authors.lastname: Bonatti
mesh_terms: D000328:Adult; D000368:Aged; D000075202:Contraindications; D001026:Coronary Artery Bypass / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000601:surgery*