Minimally Invasive Approach To Re-operative Cabg Surgery Utilizing The Davinci Robot
Arthur T. Martella, III, Jane Cichelli, PA-C.
Virtua 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 1, 2020. RESULTS: During the study period 732 robotic assisted MIDcab procedures were completed at our institution of which 35(4.7%) were re-operative procedures. Median age was 69 years old (range 32 to 81) and 24 were male (75%). A LIMA was utilized in 24 and a RIMA in 11 patients. There were four patient groups at presentation: 1) LIMA not utilized (19 patients), 2) LIMA occluded (6 patients), 3) LIMA patent with distal disease (5 patients), and 4) LIMA patent with other disease (3 patients). There one 30-day mortality. 28 of 35 patients had pedicled mammary artery grafts. Mean length of stay was 5.8 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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