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Early experience of minimally invasive totally endoscopic robotic-enhanced beating heart and hybrid myocardial revascularization
Vladimir Uspenskiy, Irina Belyaninova, Dmitry Zverev, Jean-Luc Jansens, Michael Gordeev.
Almazov Federal Heart, Blood and Endocrinology Centre, St Petersburg, Russian Federation.

OBJECTIVE: Robotic-assisted coronary artery bypass grafting (CABG) in patients with ischemic heart disease was intended to improve post-operative recovery and cosmesis by minimizing surgical trauma. We report our early experience with beating heart robotic-enhanced totally endoscopic coronary artery bypass (TECAB) and hybrid minimally invasive myocardial revascularization.
METHODS: Since November, 2011 we performed five robotic-assisted CABGs. All patients were males aged 57, 48, 50, 63 and 57 years. 4 patients had single-artery lesion (significant stenosis or occlusion of LAD proximal segment). 1 patient had complex lesion of main LCA, proximal LAD and LCx segments. One patient underwent unsuccessful PCI LAD 3 days prior to TECAB. All patients had normal or slightly enlarged left ventricle, ejection fraction was normal or moderately decreased. No surgical post-infarction left ventricle aneurysm was diagnosed.
RESULTS: Hospital mortality was 0%. 1 patient required conversion to sternotomy during LIMA harvesting due to inadequate visualization of its distal segment and risk of heart injury. The medium operation time in TECAB cases was 260,00 + 63,38 (165 - 295) minutes. The medium blood loss in ER was 80,00 + 57,15 ml (20 - 150) ml. All patients moved from ER to common ward the next day after surgery. Further post-operative period was uneventful. The patient with complex coronary lesion underwent PCI of left main LCA and proximal LCx on the post-operative day 5 (Figure 1A - LIMA-LAD graft angiography, Figure 1B - final result after PCI). All patients were discharged in a good condition on the post-operative day 8.
CONCLUSIONS: Robotic-enhanced totally endovascular beating-heart CABG and hybrid approach have potential advantages of providing an efficient myocardial revascularization. Obviously, the reason for conversion was suboptimal port placement. Further investigations, patient selection and gaining experience are needed.


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