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Robotic Total Arterial Off-pump Coronary Artery Bypass Grafting: 7-year Single-center Experience and Long-term Follow-up of Graft Patency
Changqing Gao, Ming Yang, Huajun Zhang, Yang Wu, Cangsong Xiao, Gang Wang, Jiali Wang.
PLA General Hospital, Beijing, China.

OBJECTIVE: This study aims to summarize the 7-year surgical experience with robotic coronary artery bypass grafting (CABG) and demonstrate the long-term follow-up results of the graft patency.
METHODS: Between January 2007 and November 2014, a total of 240 patients (187 male) at a mean age of 59 years (range, 33 to 80 years) underwent robotic off-pump CABG with da Vinci Surgical System (Intuitive Surgical, USA) in our institution. Totally endoscopic coronary artery bypass (TECAB) or minimally invasive directed coronary artery bypass (MIDCAB) was performed and skeletonized IMA conduits were used. The blood flow in the grafts was measured with Medistim VeriQC system (Medistim ASA, Norway). The patients were followed up after surgery and the coronary angiography or CT angiogram (CTA) was performed to evaluate the IMA graft patency.
RESULTS: A hundred patients underwent TECAB (41.7%) and 140 patients required MIDCAB (58.3%). Most patients had localized LAD disease and received single IMA graft (98.3%) and 4 received bilateral IMA grafting (1.7%). All cases were completed successfully without conversion to median sternotomy. No operative mortality or major complication was observed. A median of one graft was needed. The mean of graft flow was (36.8±18) ml/min in TECAB group, and (22.1 ± 13.9) ml/min in MIDCAB group. Coronary angiography or CTA showed 100% graft patency before discharge. During the follow-up, the IMA graft patency was 98.1% at 1 year, and 97.8% at 2 years after surgery. No IMA occlusion was found yet at 3 to 5 years postoperatively.
CONCLUSIONS: Robotic arterial off-pump CABG is safe and effective procedure for selected patients and the long-term graft patency is excellent.

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