Abstract 16472: Robotic Totally Endoscopic Coronary Artery Bypass Grafting - Approaching 500 Cases
Objective: Robotic technology has enabled performance of closed chest, port-only, and totally endoscopic coronary artery bypass grafting (TECAB). Graft harvesting and anastomotic suturing are carried out using telemanipulation systems. Procedure development is slow but steady. Only few larger series have been published. We report a two center experience.
Methods: From October 2001 to May 2011 480 patients age 60 (31-90) with a EuroSCORE of 2 (0-13) underwent TECAB using the daVinci, daVinci S, and daVinci Si telemanipulation systems. Three hundred twenty single, 145 double, 14 triple, and 1 quadruple coronary artery bypass grafting procedures were carried out. Two hundred and twelve were performed as part of hybrid coronary interventions.
Results: Four hundred eighteen (87.1%) operations were completed in endoscopic fashion. The following perioperative morbidities were observed: revision for bleeding 29 (6.0%), low cardiac output syndrome requiring an intraaortic balloon pump 7 (1.5%), renal failure requiring replacement therapy 7 (1.5%), stroke 8 (1.7%), deep thoracic wound infection 2 (0.4%). Hospital mortality was 2 (0.8%), ventilation time was 9 (0-349 ) hours, hospital stay was 6 (2-54) days. Due to preserved sternal stability early return to all activities was noted: time to walking outside 7 (1-180) days, time to household work 17 (2-360) days, time to driving 21 (5-180) days, time to full activity including sports 45 (10-720) days. Five year survival was 94%, five year freedom from major adverse cardiac and cerebral events (MACCE) was 81%.
Conclusion: Robotically assisted totally endoscopic coronary artery bypass grafting can be introduced with adequate safety. Multivessel bypass grafting is feasible. Major advantages are observed during the early rehabilitation phase. Intermediate term results seem to meet the standards of open coronary bypass surgery.
- © 2011 by American Heart Association, Inc.