title: Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery.
abstract: OBJECTIVE
  Robotic-assisted coronary artery bypass grafting has emerged as an alternative to traditional coronary artery bypass grafting or percutaneous intervention for patients with coronary artery disease. However, the safety and efficacy of this minimally invasive procedure have not been established in large series.
  
  
  METHODS
  From October 2009 to September 2012, 307 consecutive robotic-assisted coronary artery bypass grafting procedures were performed at a single US institution by 2 surgeons. Isolated, off-pump, left internal thoracic artery to left anterior descending coronary artery grafting was planned via a 3- to 4-cm non-rib-spreading minithoracotomy after robotic left internal thoracic artery harvest in all patients. Hybrid coronary revascularization was planned in 159 patients (51.8%). Of the 199 angiograms (64.8%) performed before discharge, 63 were performed as completion angiograms in a hybrid suite immediately after left internal thoracic artery-left anterior descending artery grafting.
  
  
  RESULTS
  Thirty-day mortality occurred in 4 patients (1.3%), conversion to sternotomy occurred in 16 patients (5.2%), postoperative myocardial infarction occurred in 5 patients (1.6%), and reexploration for bleeding occurred in 7 patients (2.3%). There was 1 (0.3%) postoperative stroke. For the 199 patients with follow-up angiography before discharge, the left internal thoracic artery was confirmed to be patent (<50% stenosis) in 189 patients (95.0%). Among the 10 patients with significant (≥50% stenosis) defects, 5 had graft occlusion or distal left anterior descending occlusion, 2 had poor flow distal to the anastomosis, and 3 had anastomotic lesions (≥50% stenosis). Among the 63 patients with intraoperative completion angiography, 5 patients underwent surgical graft revision, 3 patients underwent minithoracotomy, and 2 patients underwent conversion to sternotomy.
  
  
  CONCLUSIONS
  Robotic-assisted coronary artery bypass grafting is an effective alternative to traditional coronary artery bypass grafting for patients with single or multivessel coronary artery disease, with comparable short-term clinical and angiographic results.
authors.affiliation: The Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga. Electronic address: mhalkos@emory.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Halkos
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Liberman
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Chandan
authors.initials: C
authors.lastname: Devireddy
authors.affiliation: The Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Patrick
authors.initials: P
authors.lastname: Walker
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Aloke V
authors.initials: AV
authors.lastname: Finn
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Wissam
authors.initials: W
authors.lastname: Jaber
authors.affiliation: The Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.affiliation: The Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
mesh_terms: D000368:Aged; D002983:Clinical Competence; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005845:Georgia; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D012371:Robotics; D056346:Sternotomy; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome
keywords: 23; 28; CAB; CABG; LAD; LITA; MIDCAB; OR; PCI; PROM; TECAB; coronary artery bypass; coronary artery bypass grafting; left anterior descending; left internal thoracic artery; minimally invasive direct coronary artery bypass; operating room; percutaneous coronary intervention; predicted risk of mortality; totally endoscopic coronary artery bypass