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TECAB- Indian Experience
Sandip Sardar.
Manipal Hospital,Mukundapur, kolkata, India.
BACKGROUND: Totally endoscopic coronary artery bypass grafting (TECAB) is a groundbreaking and evolving surgical technique offering a minimally invasive alternative to conventional coronary artery bypass grafting (CABG). Unlike traditional methods, TECAB eliminates the need for sternotomy, using a fully endoscopic approach with three ports and 2D camera guidance to achieve optimal coronary revascularization. Although technically demanding, TECAB has demonstrated comparable outcomes to traditional CABG in terms of graft patency, left ventricular (LV) function, and postoperative mortality. It significantly reduces postoperative pain, hospital stay, and morbidity. This study presents our initial experience with 233 cases of TECAB, evaluating its feasibility, safety, and clinical effectiveness.
METHODS: A prospective analysis of 233 patients who underwent TECAB between 2021 and 2024 was conducted. Data were collected on patient demographics, procedural details, perioperative outcomes, LV function, and major complications over a follow-up period of one year. All procedures were performed using a totally endoscopic approach under cardiopulmonary bypass (CPB).
RESULTS: The study population consisted of 59% males, with a mean age of 57 ± 7.5 years and an average EuroSCORE II of 1.94 ± 0.54. Of the patients, 15% had single-vessel disease, and 85% had multi-vessel disease. The mean operative time was 345 ± 66.2 minutes, and the average hospital stay was 2.7 ± 0.8 days. The conversion rate to open surgery was 1.4%. Major complications included bleeding (2.4%), cerebrovascular accidents (0.5%), and graft failure (1.1%). The one-year mortality rate was 1.1%. Postoperative angiographic studies revealed a graft patency rate of 98.9% at the 12-month follow-up. High patient satisfaction scores were attributed to reduced pain, minimal scarring, and faster recovery.
CONCLUSIONS:Our findings confirm that TECAB is a safe and effective alternative to conventional CABG, offering excellent outcomes in graft patency, LV function preservation, and low postoperative mortality. Despite its steep learning curve, TECAB provides significant benefits, including reduced postoperative pain, fewer complications, and expedited recovery, improving overall patient satisfaction and quality of life. TECAB is a promising advancement in minimally invasive cardiac surgery, capable of achieving outcomes equivalent to traditional CABG while minimizing surgical trauma and morbidity. Further studies and long-term follow-ups are warranted to establish TECAB as a standard practice in coronary artery surgery.
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