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Objective: Robotic totally endoscopic coronary artery bypass (TECAB) of the left anterior descending artery (LAD) has been introduced in the clinical setting using a wrist enhanced computer assist device to provide a minimally invasive therapeutic strategy. Previous clinical results were focused on the initial hospital course of patients (pts). We report the first five year follow up of patients after TECAB in a single centre.
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Utz Kappert, Sems Tugtekin, Romuald Cichon, Klaus Matschke.
Cardiac Surgery, Heart Center, Dresden, Germany.
Methods: From 05/1999 to 06/2001 41 pts (36 male, 5 female; mean age 60 ± 8.9 years) underwent TECAB for isolated high grade LAD lesions by means of the da Vinci system (Intuitive Surgical, Inc, Mountain View, CA). Follow up for all pts was performed after five years. Primary end point of the follow up were freedom from major adverse cardiac events (MACE) such as death, myocardial infarction, need for reintervention and freedom from angina.
Results: Hospital survival was 100%. Freedom from reintervention of the target vessel after six months was 92.7% (38/41 pts). Overall survival after five years was 92.7% (38/41pts). Three pts (7.3%) died due to non cardiac reasons. In the midterm follow up two more pts needed target vessel reintervention. In total five pts needed a reintervention (5/38pts 13%). Myocardial infarction occurred in two pts (5.2%). Freedom from major adverse cardiac events during the whole follow up was 75.7% (10/41pts).
Conclusions: Earlyrobotic TECAB procedure results were promising. Clinical outcome was similar compared to other minimally invasive surgical revascularization strategies for isolated LAD lesions. However in the midterm follow up (five years) the clinical outcome was restrictive concerning freedom of MACE. Further development of this technology might have had a beneficial impact on patient outcome.
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