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OBJECTIVE: Despite the early introduction of totally endoscopic coronary artery bypass on beating heart (BH TECAB), only a limited number of cases have been performed. The limiting factor has been the concern about safety and graft patency of the anastomosis. This study describes our experience with BH TECAB with robotic assistance and its early and midterm results.
METHODS: In 500 cases of robotic cardiac operations, 225 patients underwent robotic CABG on beating heart, in which 80 patients (59/M, 21/F) underwent BH TECAB. Mean age was 66.87 ± 7.7 (33 to 79) years. LIMA to LAD anastomosis was performed using U-CLIP.
RESULTS: 78 TECAB procedures were completed, in which 26 patients received hybrid procedures. Two patients were converted to minithoracotomy. The average LIMA harvesting and anastomosis times were 25.3 ± 11.5 (15~55) min and 10.3 ± 4.7 (5~21) min respectively. The mean operating room and operation times were 306.1 ± 53.5 (198~580) min and 244.8 ± 55.6 (130~420) min respectively. The drainage was 154.9 ± 53.2 (70~450) ml. Before discharge, 68 patients underwent angiography and 12 patients underwent CTA scan, and the study showed that graft potency was 100% and unexpectedly, LIMA graft had a collateral branch in 2 patients. After discharge, all patients were followed up by CTA scan, average follow-up time was 18.67±9.43 (1 to 51 months). One patient had gastric bleeding after surgery.
CONCLUSIONS:
BH TECAB is a safe procedure in selected patients and produces excellent early and midterm patency of anastomosis.