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Objective: Suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting (TECAB) on the beating heart is still technically demanding. The potential benefits of an endoscopic anastomosis, based on a catheter guided construction, to facilitate performance of a coronary anastomosis in a closed chest environment were evaluated.
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Stephan Jacobs, Volkmar Falk, David Holzhey, Friedrich W. Mohr.
Cardio-Thoracic-Surgery, Heartcenter Leipzig, Leipzig, Germany.
Methods:
TECAB on the beating heart was performed in six pigs with the daVinci telemanipulation system (Intuitive Surgical, Mountain View, CA). An angiographic PTCA catheter (Monorail Maverick² 4.0mm x 20mm PTCA Dilatation Catheter; Boston Scientific) was used to guide and place the anastomotic side of the Left Internal Thoracic Artery (LITA) to the Left Anterior Descending Artery (LAD). Connection of the coronary anastomosis was performed by gluing the surrounding tissue of the LITA to the LAD while the anastomosis was stabilized and kept open with the balloon catheter. After two minutes the catheter was released and an angiography was performed; gross inspection of the anastomotic site was performed after excision of the hearts.
Results:
The procedure was accomplished in all animals in 98 minutes (88-125). Positioning of the stabilizer (5.5 minutes; 3-7.5), placement of occlusion tapes (4.3 minutes, 3-7) and arteriotomy 2.5 minutes (1.4-3.3) were achieved without problems. The angiography and catheter placement at the graft site was performed with the graft still in situ. The anastomotic constructions were easily accomplished in 3.5 minutes (2-7). The following adverse events were encountered: Anastomotic leakage upon reperfusion requiring another dose rate of glue (1), LAD dissection due to the steerable guidewire (2). All except one animal with a patent graft and anastomosis survived the procedure. Over all patency was 5/6.
Conclusion:
The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and this simple yet effective and time saving technique for anastomotic construction may facilitate beating heart TECAB.
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