Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery.
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.
['Halkos|Michael E|ME|', 'Liberman|Henry A|HA|', 'Devireddy|Chandan|C|', 'Walker|Patrick|P|', 'Finn|Aloke V|AV|', 'Jaber|Wissam|W|', 'Guyton|Robert A|RA|', 'Puskas|John D|JD|']
D000368:Aged D002983:Clinical Competence D017023:Coronary Angiography D047549:Coronary Artery Bypass, Off-Pump D003324:Coronary Artery Disease D005260:Female D005845:Georgia D006801:Humans D007387:Internal Mammary-Coronary Artery Anastomosis D059032:Learning Curve D008297:Male D008875:Middle Aged D011183:Postoperative Complications D011237:Predictive Value of Tests D012086:Reoperation D012189:Retrospective Studies D012371:Robotics D056346:Sternotomy D025321:Surgery, Computer-Assisted D013908:Thoracotomy D013997:Time Factors D016896:Treatment Outcome
coronary artery bypass coronary artery bypass grafting OR left anterior descending left internal thoracic artery 23 28 CAB CABG LAD LITA MIDCAB PCI PROM TECAB minimally invasive direct coronary artery bypass operating room percutaneous coronary intervention predicted risk of mortality totally endoscopic coronary artery bypass