Long-term Follow-up for Grafts Patency of Totally Robotic Coronary Artery Bypass Grafting on Beating Heart
Changqing Gao, Ming Yang.
PLA General Hospital, Beijing, China.
OBJECTIVE: The totally robotic coronary artery bypass grafting on beating heart (BH TECAB) is the most minimally invasive procedure for coronary artery bypass graft. The long-term follow-up for graft patency of BH TECAB is needed to determine.
METHODS: In 650 cases of robotic cardiac operations, in which 100 patients underwent selective BH TECAB procedures from 2007 to 2013 in General Hospital. There were 86 male and 14 female with a median age of 57 (rang, 33~79) years old. Through 3 ports incisions in the left chest the internal thoracic artery (ITA) was harvested robotically in a skeletonized fashion. And totally robotic ITA to target vessel anastomosis was performed using U-Clip on beating heart. The coronary angiography or CTA was performed to evaluate the patency of ITA graft before discharge and 1 to 5 years postoperatively. The patients with multiple vessels diseases accepted a staged hybrid revascularization. The clinical follow-up for major adverse cardiac events (MACE) as cardiac death, acute myocardial infarction and target lesion revascularization was performed.
RESULTS: All the patient accepted successfully BH TECAB procedure, in which 18 patients received hybrid procedures. The mean operation time was 150.1±28.9 (120 to 188) minutes. The average coronary occlusion time and anastomosis time were 19.5±6.7 minutes (7 to 41) and 9.9±4.1 (5~21) minutes respectively. The significant learning curves were observed for anastomosis and operation time. The average graft flow was 35.8±20.0 ml/min (10 to 103). No patient had angina after surgery. Before discharge, all the patients accepted CTA or coronary angiography follow-up. Both angiography and CTA scan showed 98.1% graft patency and unexpectedly, ITA graft developed a collateral branch in 2 patients. After discharge, all patients were followed up by CTA scan, average follow-up time was 37.6(1~79)month. One graft occlusion was found in 1 year postoperatively. And no more graft occlusion was found at 3 to 5 years. The clinical outcome demonstrated 100% survival, freedom from angina and any form of coronary revascularization.
CONCLUSIONS: BH-TECAB is a safe procedure in selected patients, and has excellent long-term patency.
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