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Robotic Minimally Invasive Direct Coronary Artery Bypass With Concomitant Epicardial Maze Procedure
Emily Bach, BA, Amber Edwards, MD.
Ascension Saint Thomas West, Nashville, TN, USA.
BACKGROUND: Coronary artery disease (CAD) and atrial fibrillation (AF) have overlapping risk factors and often occur concomitantly. There are no previous reports of robotic minimally invasive direct coronary artery bypass (MIDCAB) and epicardial MAZE performed at the same time. The objective of this research is to describe a minimally invasive way of addressing both diseases concomitantly.
METHODS: This is a case series of adults who underwent robotic MIDCAB with concomitant epicardial Maze procedure at a single institution between January 2024 and December 2025. Baseline characteristics, operative variables, and postoperative events were extracted through patient charts and the STS Adult Cardiac Surgery Database. The primary endpoint was 30-day mortality. Secondary endpoints were ICU and hospital length of stay (LOS), postoperative morbidity, and discharge location.
RESULTS: Six procedures were performed during the study period. All MIDCAB operations were single-vessel revascularization with left internal thoracic artery to left anterior descending artery. Epicardial MAZE was performed using the commercially available EPi-sense™ device. These patients had an average age of 78 and were majority (5/6, 83%) male. Five patients (83%) had multivessel coronary disease, and all patients had a history of AF. Average operative time was 5.9 hours (range: 4.6-6.9). There were no 30-day mortalities. Mean postoperative LOS was 11 days (range: 3-37). Mean ICU stay was 91 hours (range: 19-292). One patient (17%) was discharged to rehabilitation; all others were discharged home.
CONCLUSIONS: Robotic MIDCAB with concomitant epicardial Maze is an innovative, minimally invasive approach to treating comorbid CAD and AF. This series demonstrates the procedure"s potential to reduce morbidity and enhance recovery for selected patients. Expanding awareness and accessibility may encourage broader adoption of the technique.
LEGEND: AF = atrial fibrillation; BMI = body mass index; CAD = coronary artery disease; ICU = intensive care unit; LAA = left atrial appendage; LAD = left anterior descending artery; LITA = left internal thoracic artery; LOS = length of stay; MIDCAB = minimally invasive direct coronary artery bypass; NSTEMI = non-ST-elevation myocardial infarction; OM = obtuse marginal artery; OR = operating room; PCI = percutaneous coronary intervention; RCA = right coronary artery; Rf = radiofrequency.
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