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A Paradigm shift in Coronary Revascularization - 1021 Consecutive Robot Assisted Coronary Artery Bypass Procedures
Francis P. Sutter, DO, MaryAnn C. Wertan.
Lankenau Hospital, Wynnewood, PA, USA.

OBJECTIVE: Robotic assisted technology is responsible for introducing a new era in coronary revascularization. Significant benefits of the robotic approach include: survival benefit of LIMA to LAD, avoiding heart lung machine with beating heart surgery performed and reducing trauma to patient via a non-rib spreading, mini-thoracotomy. We show a paradigm shift in our institution’s treatment of coronary revascularization.
METHODS: We describe a single center experience of minimally invasive robotic oronary surgery from inception, 05/2005 -12/2013. Our technique places the endoscopic port over the LAD target, with subsequent port conversion to “precision incision” mini-thoracotomy allowing beating heart coronary bypass to be performed.
RESULTS: 1021 consecutive robot mini-thoracotomy CABG are reported; results are seen in table below. A mean incision size 4.2 cm in last 732 cases. 397 of 1021 underwent hybrid revascularization, subset revealed LIMA patency 96.6% in those having postoperative catheterization, n = 119.
Importantly since 2007, robotic CABG is routinely performed and accounts for 41.5%-51.8% of all CABG performed at our institution. Similarly and collaboratively, interventional cardiologists have embraced robotic CABG as a valuable alternative, for past 3 years 46-54% of our robot CABG population underwent staged hybrid revascularization
CONCLUSIONS: This technique is safe, reproducible and yields outstanding results. It has saved lives, even offering an alternative to sickest patients with multivessel disease, clearly demonstrating the true value of LIMA to LAD. Our center has had a dramatic paradigm shift in the treatment of CAD with half of all CABG at our institution having the robotic precision incision.

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