SUDHIR SRIVASTAVA, MD, ZOILA REYNA BARRERA, PAC, SHAUNE QUISMUNDO, RN.
Univ. of Chicago Medical Center, Chicago, IL, USA.
BACKGROUND
Left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery bypass has proven long term patency resulting in better long term survival. However, percutaneous coronary intervention (PCI) continues to dominate and single vessel coronary artery bypass surgery (CABG) is rare. The authors report a single surgeon experience of 149 consecutive single vessel LIMA to LAD CABG patients in beating heart robotically assisted totally closed chest approach and compare their results with reported PCI results in LAD.
METHODS
From February 2003 to the present, 81 male and 68 female patients underwent beating heart totally endoscopic coronary artery bypass (BH TECAB). Mean age was 67.7 + 11.5 years (median 69 years). Nine (6%) patients were excluded or converted intraoperatively to thoracotomy for completion of procedure. In 140 patients, CABG was performed using the da Vinci surgical system and an endoscopic stabilizer inserted through port incisions. In situ LIMA to LAD anastomosis was performed using surgical U-Clips. Thirty (21.4%) patients underwent planned hybrid revascularization. To assess early graft patency, computed tomography or conventional angiography was done in 110 (78.5%) patients.
RESULTS
Mean operative time was 172.3 + 51.5 minutes (median 159 minutes). Mean anastomotic time was 12.8 + 6.4 minutes (median 11 minutes). Hospital length of stay was 3.3 + 1.9 days (median 3 days). There was no in hospital mortality, CVA or MI. At the time of study, 109/110 (99%) grafts were found to be patent. All patients demonstrated freedom from major adverse cardiac events in the follow up period.
CONCLUSION
LIMA to LAD robotically assisted beating heart TECAB as a revascularization option shows excellent early results without need for target vessel reintervention as reported with PCI.
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