Robotic Assisted Minimally Invasive Multiple Vessel Coronary Bypass Guided By Computerized Tomography
Gökhan Arslanhan1, Sahin Senay1, Murat Bastopcu2, Muharrem Kocyigit1, Aleks Degirmencioglu1, Deniz Alis1, Cem Alhan1.
1Acibadem Mehmet Ali Aydinlar University School of Medicine, ISTANBUL, Turkey, 2Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, ISTANBUL, Turkey.
Background
Minimally invasive coronary revascularization offers a less traumatic operation with accelerated recovery for coronary bypass patients. Robotic-assisted minimally invasive multivessel surgery is one of the least invasive approaches for coronary bypass surgery. We investigated the safety and benefits of Computed Tomography (CT) guidance in robotic coronary bypass (RCAB) by analyzing the perioperative outcomes.MethodsBetween April 2022 and December 2022, 38 consecutive patients who underwent RCAB under preoperative CT guidance were included in the study. The decision of the intercostal space to perform the minithoractomy was made based on the distance to the mid-section of the LAD from the skin using preoperative CT. The cannulation site was determined based on peripheral vascular findings on preoperative CT. Perioperative parameters and early outcomes were evaluated.ResultsThirty of the patients were male (78.9%) and the mean age was 62.4± 10.2 years. The mean number of revascularized vessels was 2.7±1.0. Left thoracotomy guided by CT measurements was performed in the 4th intercostal space in 30 (78.9 %) patients and in the 3rd intercostal space in the remaining patients. Axillary cannulation was performed in 16(34.2%) patients because of prohibitive findings in the iliac vessels and aorta. The mean cross-clamp time was 63.3 ± 37.3 minutes and mean cardiopulmonary bypass time was 136.4 ± 66.5 minutes. 100% of the target coronary arteries with an indication for bypass were revascularized with CT-guided RCAB. The left internal mammarian artery (LIMA) was anastomosed to the left anterior descending artery in all patients and the LIMA was anastomosed sequentially to the diagonal artery in 13 patients (34.2%). No operative mortality or cerebrovascular event was observed among the study patients. One patient underwent reoperation due to bleeding.ConclusionsRobotic-assisted minimally invasive multiple vessel coronary bypass under preoperative CT guidance is safe and can be performed with excellent results.
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