Journal
ANNALS OF THORACIC SURGERY
Volume 81, Issue 5, Pages 1666-1675Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.athoracsur.2005.11.007
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Background. Robotic technology has been proven safe and efficacious in the performance of mitral valve repair and atrial septal defect repair. This report describes a Food and Drug Administration- sanctioned multicenter study of the safety and efficacy of the da Vinci system ( Intuitive Surgical, Inc, Mountain View, CA) for totally endoscopic coronary artery bypass ( TECAB) surgery. Methods. Patients requiring left anterior descending ( LAD) coronary artery revascularization were eligible. The procedure was performed with femoro- femoral cardiopulmonary bypass ( CPB), endoaortic balloon occlusion, and thoracoscopy. All aspects of the procedure were performed with the robotic system, from internal mammary artery harvest to coronary anastomosis. Results. Ninety- eight patients requiring single- vessel LAD revascularization were enrolled at 12 centers. Thirteen patients ( 13%) were excluded intraoperatively ( eg, failed femoral cannulation, inadequate working space). In 85 patients ( 69 men, age 58 +/- 10 years) who underwent TECAB, CPB time was 117 +/- 44 minutes, cross- clamp time was 71 +/- 26 minutes, and hospital length of stay was 5.1 +/- 3.4 days. There were five ( 6%) conversions to open techniques. There were no deaths or strokes, one early reintervention, and one myocardial infarction ( 1.5%). Three- month angiography was performed in 76 patients, revealing significant anastomotic stenoses (> 50%) or occlusions in 6 patients. Overall freedom from reintervention or angiographic failure was 91%. Conclusions. Robotic TECAB was accomplished with no mortality, low morbidity, and angiographic patency and reintervention rates comparable with published data. Although the use of CPB was a limitation of the technique, this experience represents a step toward more advanced procedures, such as multivessel or off- pump TECAB.
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