Feasibility, safety, and efficacy of totally endoscopic coronary artery bypass grafting: Multicenter European experience

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 134; no. 3; pp. 710 - 716
• Main Authors: de Cannière, Didier, MD, PhD, Wimmer-Greinecker, Gerhard, MD, PhD, Cichon, Romuald, MD, Gulielmos, Vassilios, MD, Van Praet, Frank, MD, Seshadri-Kreaden, Usha, MSc, Falk, Volkmar, MD, PhD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.09.2007; AATS/WTSA; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Coronary Artery Bypass - methods; Coronary heart disease; Endoscopy; Europe; Feasibility Studies; Heart; Humans; Medical sciences; Middle Aged; Robotics; Safety; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Europe; major adverse cardiac event; 14; totally endoscopic coronary artery bypass grafting; ECG; electrocardiography; STS; TECAB; CPB; MACE; cardiopulmonary bypass; Society of Thoracic Surgeons; CABG; coronary artery bypass grafting; Heart; Toxicity; Multicenter study; Cardiovascular disease; Thorax; European; Coronary heart disease; Experience; Coronary artery bypass; Efficiency; Complication; Graft; Feasibility; Endoscopy; Safety; Public health
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2006.06.057

Objective The invention of robotic systems has begun a new era of endoscopic cardiac surgery. Reports on totally endoscopic coronary artery bypass grafting are limited, however, and data regarding feasibility, safety, and efficacy are needed to determine this technique’s position in the therapeutic armamentarium. This study describes the largest multicenter experience in the literature with robotic totally endoscopic coronary artery bypass grafting specifically addressing procedural feasibility, safety, and efficacy. Methods Between September 1998 and November 2002, a total of 228 patients with coronary artery disease were scheduled for totally endoscopic coronary artery bypass grafting with the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, Calif.) at five European institutions. Patients underwent totally endoscopic coronary artery bypass grafting with either an on-pump (group A, n = 117) or an off-pump approach (group B, n = 111). Patients underwent postoperative angiography or stress electrocardiography and were followed up for 6 months. Results Procedural feasibility was demonstrated through the completion of 164 successful totally endoscopic cases. Sixty-four patients (group C, 28%) had conversion to nonrobotic procedures. Conversion rates decreased with time. The overall procedural efficacy, as defined by angiographic patency or lack of ischemic signs on stress electrocardiography, was 97%. The incidence of major adverse cardiac events within 6 months was 5%. Conclusion Both on- and off-pump totally endoscopic coronary artery bypass grafting are feasible, with a conversion rate that diminishes with increasing experience. Conversion does not adversely affect outcome and thus constitutes a safe alternative. Although target vessel reintervention may be slightly higher than that reported for open coronary artery bypass grafting, graft patency and major adverse cardiac events for both approaches are comparable to those reported in the Society of Thoracic Surgeons database, demonstrating the safety and efficacy of the totally endoscopic coronary artery bypass grafting procedure.