Non-sternotomy Re-operative Coronary Bypass Grafting Utilizing The Davinci Robot
Arthur T. Martella, III1, Charles Stivala2
1Virtua Health, Camden, NJ, USA, 2Virtua Health System, Camden, NJ, USA
Background. Re-operative CABG continues to have significant morbidity and mortality. Off-pump techniques combined with a non-sternotomy approach provides a potentially safe alternative to redo sternotomy. The Davinci robot allows for non-sternotomy approach for mammary artery harvesting and safe dissection of mediastinal adhesions. Methods. Since 2011, we have utilized non-sternotomy approaches to coronary disease utilizing the Davinci robot. A retrospective review was performed of all patients undergoing re-operative coronary artery bypass grafting from January 1, 2015 to December 15, 2018. Results. During the study period 602 robotic assisted MIDcab procedures were completed at our institution of which 32(3%) were re-operative procedures. Median age was 68 years old (range 32 to 79) and 24 were male (75%). A LIMA was utilized in 22 and a RIMA in 10 patients. There were four groups of patients: 1) LIMA not utilized (19 patients), 2) LIMA occluded (6 patients), 3) LIMA patent with distal disease (4 patients), and 4) LIMA patent with other disease (3 patients). There were no 30-day mortalities. Mean length of stay was 4.8 days. 16 patients required at least one unit of PRBCs. There were no conversions to sternotomy. Conclusions. Use of minimally invasive techniques with the DaVinci robot allows for a non-sternotomy approach for re-operative coronary surgery. This approach provides a safe alternative to redo sternotomy in selected patients.
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