Results of the prospective multicenter trial of robotically assisted totally endoscopic coronary artery bypass grafting

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.