Back to Annual Meeting Posters

OBJECTIVE: There are several cohort studies and cases reports concerning minimally invasive coronary surgery, but just a few are randomized controlled trials. The aim of this trial is to compare minimally invasive LIMA to LAD coronary surgery (MICS) bypass with conventional LIMA to LAD coronary surgery (CCS) off-pump bypass.

METHODS: From 2007 to 2010, 36 patients were randomized to either LIMA robotically harvested to LAD artery minimally invasive bypass or conventional LIMA to LAD off-pump bypass. Patients assigned to MICS group underwent robotic endoscopic harvesting of LIMA with the AESOP system followed by a small left thoracotomy in the 4^th intercostal space for off-pump LAD bypass. Patients assigned to CCS group underwent full median sternotomy, open LIMA harvesting followed by off-pump LAD bypass. Transit time flow measurement (Medi-Stim Butterfly Medtronic Inc., Minneapolis, MN) was used for intraoperative evaluation of LIMA to LAD patency. After a mean 24-month follow-up, Multislice Computed Tomography (Aquilion® ONE 320, Toshiba America Medical Systems, Inc., Tustin, CA) was used to evaluate LIMA to LAD midterm patency.

RESULTS: The mean LIMA harvesting time in robotic group was 50.8 ± 11.2 min vs. 22.7 ± 3.4 min in conventional group. There was no significant difference in intraoperative LIMA to LAD flow between MICS and CCS groups (46.18 ± 20.73 mL/min vs. 48.65 ± 24.15 mL/min, p=0.84). There were no significant differences in incidence of wound infection (0 vs. 2, p=0,484) and reoperation for bleeding (0 vs. 1, p=1.00) between MICS and CCS groups respectively. In MICS group, Multislice CT revealed patent LIMA graft in 18 (100%) patients vs. 17 (94.4%) patients in CCS group (p=1.00). There was no mortality in the study group.

CONCLUSIONS: Minimally invasive LAD bypass using LIMA graft robotically harvested was safe and feasible. Early and mid-term LIMA patency was similar between both techniques.