Original articles
Cardiovascular
Robotic Assisted Multivessel Minimally Invasive Direct Coronary Artery Bypass With Port-Access Stabilization and Cardiac Positioning: Paving the Way for Outpatient Coronary Surgery?

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
https://doi.org/10.1016/j.athoracsur.2004.10.067Get rights and content

Background

Minimimal access multivessel coronary artery bypass grafting with same day hospital discharge remains the ultimate goal. We evaluated the feasibility for achieving multivessel coronary bypass through minimal access.

Methods

From January to July 2003, 30 patients under went off-pump minimally invasive multivessel coronary bypass. Internal mammary arteries were harvested with robotic telemanipulation with three ports. A 2-inch to 3-inch incision with soft tissue retractor was used to perform coronary anastomosis. Robotic ports were used to introduce stabilization and cardiac positioning devices. Endoscopic harvesting of radial artery was done when necessary.

Results

Twenty-three patients (77%) had anterior throracotomy approach and 7 (23%) had transabdominal approach. Average number of bypass grafts was 2.6 (range 2–4). There was no mortality in hospital or on 30-day follow-up. Twenty-nine patients (97%) were extubated on the operating table. Two patients required reoperation for bleeding and 1 of those patients needed conversion to sternotomy for additional bypass grafting. Within 24 hours of surgery 50% of patients (n = 15) were discharged, 10% (n = 3) were discharged in 24 to 36 hours, 17% (n = 5) were discharged in 36 to 48 hours, 17% (n = 5) were discharged in 48 to 72 hours, and 2 patients stayed more than 3 days in the hospital. Two patients needed readmission to hospital within 30 days; 1 for pleural effusion and 1 for wound infection.

Conclusions

Robotic harvesting of internal mammary arteries and port access stabilization and cardiac positioning allows multivessel coronary bypass to be performed through a small incision. Currently, the majority of the patients can be safely discharged within 36 hours of operation.

Section snippets

Patient Characteristics

From January to July 2003, 30 patients underwent off-pump multivessel MIDCAB at Lenox Hill Hospital.

Data Collection and Follow-Up

All the preoperative, intraoperative, and postoperative variables were collected in accordance with New York State cardiac surgery reporting system. Follow-up was done either by the referring cardiologist or in our institution depending on patient's convenience.

Patient selection criteria was as follows:

  • 1

    Good size coronary artery targets greater than 1.75-mm diameter without any diffuse disease

  • 2

    All

Preoperative Characteristics

All the preoperative characteristics of the patients are listed in Table 1.

Operative Details

Twenty-three patients (77%) had left anterior thoracotomy approach, whereas 7 patients (23%) had transabdominal approach. The average total operative timing was 7 hours 24 minutes (± 49 minutes), which included anesthesia time and time needed to extubate at the end of operation. The average robotic time was 1 hour 30 minutes (± 35 minutes), which included robotic preparation time as well as harvesting of bilateral IMAs.

Comment

The initial approach for limited-access coronary artery revascularization was an anterior exposure of the heart for grafting of mid to distal left anterior descending coronary artery with pedicle left IMA conduit 2, 3. Despite initial concerns about technical difficulties of the MIDCAB operation, it has become a more standardized procedure in hands of some experts with the advent of stabilization devices 2, 3, 12, 13, 14. However, anterior MIDCAB has been predominantly limited to single vessel

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