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Thielmann M, Bonaros N, Barbato E, Barili F, Folliguet T, Friedrich G, Gottardi R, Legutko J, Parolari A, Punjabi P, Sandner S, Suwalski P, Shehada SE, Wendt D, Czerny M, Muneretto C. Hybrid coronary revascularization: position paper of the European Society of Cardiology Working Group on Cardiovascular Surgery and European Association of Percutaneous Cardiovascular Interventions. Eur J Cardiothorac Surg 2024; 66:ezae271. [PMID: 39142801 DOI: 10.1093/ejcts/ezae271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/17/2024] [Accepted: 07/10/2024] [Indexed: 08/16/2024] Open
Abstract
Myocardial revascularization in coronary artery disease via percutaneous coronary intervention or coronary artery bypass graft (CABG) surgery effectively relieves symptoms, significantly improves prognosis and quality of life when combined with guideline-directed medical therapy. Hybrid coronary revascularization is a promising alternative to percutaneous coronary intervention or CABG in selected patients and is defined as a planned and/or intended combination of consecutive CABG surgery using at least 1 internal mammary artery to the left anterior descending (LAD), and catheter-based coronary intervention to the non-LAD vessels for the treatment of multivessel disease. The main indications for hybrid coronary revascularization are (i) to achieve complete revascularization in patients who cannot undergo conventional CABG, (ii) to treat patients with acute coronary syndromes and multivessel disease with a non-LAD vessel as the culprit lesion that needs revascularization and (iii) in highly select patients with multivessel disease with complex LAD lesions and simple percutaneous coronary intervention targets for all other vessels. Hybrid coronary revascularization patients receive a left internal mammary artery graft to the LAD artery through a minimal incision along with percutaneous coronary intervention to the remaining diseased coronary vessels using latest generation drug-eluting stents. A collaborative environment with a dedicated heart team is the optimal platform to perform such interventions, which aim to improve the quality and outcome of myocardial revascularization. This position paper analyses the rationale of hybrid coronary revascularization and the currently available evidence on the various techniques and delves into the sequence of the interventions and pharmacological management during and after the procedure.
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Affiliation(s)
- Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Cardiovascular Research Center Aalst OLV Hospital, Aalst, Belgium
| | - Fabio Barili
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thierry Folliguet
- Chirurgie Cardiaque et Transplantation, Assistance Publique Hôpital Henri Mondor, Université Paris UPEC, Paris, France
| | - Guy Friedrich
- Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - Roman Gottardi
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
| | - Jacek Legutko
- Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, The John Paul II Hospital, Krakow, Poland
| | - Alessandro Parolari
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Prakash Punjabi
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre for Postgraduate Medical Education, Warsaw, Poland
| | - Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Faculty of Medicine, University Hospital Essen, Essen, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Claudio Muneretto
- Department and School of Cardiovascular Surgery, University of Brescia Medical School, Spedali Civili di Brescia, Brescia, Italy
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Torre T, Pozzoli A, Valgimigli M, Leo LA, Toto F, Muretti M, Birova S, Ferrari E, Pedrazzini G, Demertzis S. Minimally Invasive Isolated and Hybrid Surgical Revascularization for Multivessel Coronary Disease: A Single-Center Long-Term Follow-Up. J Pers Med 2024; 14:528. [PMID: 38793110 PMCID: PMC11122097 DOI: 10.3390/jpm14050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Some evidence suggests that surgical minimally invasive (MIDCAB) and hybrid coronary revascularization (HCR) are safe and potentially effective at short-term follow-up. Data on long-term outcomes are more limited and inconclusive. METHODS Between February 2013 and December 2023, a total of 1997 patients underwent surgical coronary artery revascularization at our institution, of whom, 92 (4.7%) received left anterior mini-thoracotomy access (MIDCAB), either isolated (N = 78) or in combination with percutaneous coronary intervention (N = 14, HCR group). RESULTS After a median follow-up of 75 months (range 3.1: 149 months), cardiac mortality was 0% while overall mortality was 3%, with one in-hospital mortality and two additional late deaths. Conversion to sternotomy happened in two patients (2.1%), and surgical re-explorations occurred in five patients (4.6%), of whom three for bleeding and two for graft failure. All patients received left internal mammary (LIMA) to left anterior descending artery (LAD) grafting (100%). In the HCR group, 10 patients (72%) showed percutaneous revascularization (PCI) after MIDCAB, showing PCI on a mean of 1.6 ± 0.6 vessels and implanting 2.1 ± 0.9 drug-eluting stents. CONCLUSIONS MIDCAB, in isolation or in association with hybrid coronary revascularization, is associated with encouraging short- and long-term results in selected patients discussed within a dedicated heart-team.
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Affiliation(s)
- Tiziano Torre
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Marco Valgimigli
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Laura Anna Leo
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
| | - Francesca Toto
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Mirko Muretti
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Sara Birova
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Enrico Ferrari
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Medicine, University of Zurich (UZH), 8032 Zurich, Switzerland
| | - Giovanni Pedrazzini
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Stefanos Demertzis
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
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Kyaruzi M, Gülmez H, Demirsoy E. Can Minimally Invasive Multivessel Coronary Revascularization Be a Routine Approach? Thorac Cardiovasc Surg 2023; 71:455-461. [PMID: 35644133 DOI: 10.1055/s-0042-1749209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Advancement in the field of cardiovascular surgery has emerged with various minimally invasive approaches for the treatment of multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. This study describes our routine technical approach and clinical experience of minimally invasive coronary artery bypass via left anterior minithoracotomy for the treatment of patients with multivessel coronary lesions. METHODS Our experience includes 100 consecutive patients who were operated between July 2020 and April 2021. The left internal thoracic artery was harvested in all patients. Radial arterial grafts and saphenous vein grafts were harvested endoscopically. Patients were operated either under cardiopulmonary bypass (CPB) with blood cardioplegia through left anterior minithoracotomy of 5 to 7 cm or off-pump via left anterolateral minithoracotomy. RESULTS We had single mortality (1%), no early postoperative myocardial infarction was observed. None of our patients was converted to sternotomy (0%). The mean number of bypass was 3.1 ± 0.8, the mean cross-clamping time was 78.1 ± 20.6 minutes, the mean CPB time was 153.2 ± 37.5 minutes, the average intubation time was 6.33 ± 11.29 hours, the mean intensive care unit stay was 1.62 ± 1.78 days, the mean hospital stay was 4.98 ± 3.01 days, the average total operation time was 4.20 ± 0.92 hours, and the average pleural drain was 393.8 ± 169.7 mL. CONCLUSION Minimally invasive coronary artery bypass grafting via left anterior minithoracotomy can be routinely performed with safety and it is feasible, reproducible with a short learning curve. Further multicenter studies are needed for the standardization of our technique.
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Affiliation(s)
- Mugisha Kyaruzi
- Department of Cardiovascular Surgery, Liv Hospital, Bahçeşehir, Istinye University, Istanbul, Turkey
| | | | - Ergun Demirsoy
- Department of Cardiovascular Surgery, Kolan Hospital Group, Istanbul, Turkey
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Oosterlinck W, Algoet M, Balkhy HH. Minimally Invasive Coronary Surgery: How Should It Be Defined? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:22-27. [PMID: 36762801 DOI: 10.1177/15569845231153366] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Wouter Oosterlinck
- Department of Cardiovascular Sciences, Research Unit of Cardiac Surgery, KU Leuven, Belgium
| | - Michiel Algoet
- Department of Cardiovascular Sciences, Research Unit of Cardiac Surgery, KU Leuven, Belgium
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, IL, USA
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Nisivaco SM, Kitahara H, Abutaleb AR, Nathan S, Balkhy HH. Hybrid Coronary Revascularization: Early Outcomes and Midterm Follow-Up in Patients Undergoing Single or Multivessel Robotic TECAB and PCI. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:513-520. [PMID: 36529976 DOI: 10.1177/15569845221137349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Hybrid coronary revascularization (HCR) is the integration of sternal-sparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease (CAD). It is traditionally performed with single-vessel bypass (left internal mammary artery [LIMA] to left anterior descending artery [LAD]) and PCI but can also be accomplished with multiple arterial grafts using bilateral IMA conduits. We sought to review our HCR experience over an 8-year period with robotic totally endoscopic coronary artery bypass (TECAB) and PCI. METHODS Of 694 patients undergoing beating-heart TECAB from August 2013 to June 2022, 306 patients were designated as intention-to-treat HCR candidates. Patients underwent PCI prior to, the same day as, or following TECAB, performed using single or bilateral IMA grafts. We retrospectively reviewed early and midterm outcomes up to 8 years in this cohort of patients. RESULTS The mean Society of Thoracic Surgeons predicted risk of mortality was 1.5% ± 2.5%. There were 44 patients (14%) who had ≥70% left main disease and 218 patients (71%) who had triple-vessel disease. A total of 193 patients (63%) underwent multivessel grafting (advanced HCR), with 83% bilateral IMA use. Mean operative time was 263 ± 80 min, and mean length of stay was 2.6 days. The mean number of vessels bypassed per patient was 1.7 ± 0.6. The mean number of vessels stented was 1.2 ± 0.5. Of the patients, 84% underwent TECAB first, 14% PCI first, and 2% same-day TECAB/PCI. Mortality was 0.6% (observed to expected ratio: 0.42). Early graft patency was 97% (328 of 339 grafts); LIMA-LAD patency was 98%. At 8-year follow-up (mean 37 ± 26 months), all-cause and cardiac-related mortality were 13% and 2.6%, respectively. Freedom from major adverse cardiac and cerebrovascular events was 92%. CONCLUSIONS In patients with multivessel CAD, integrating robotic single and multivessel TECAB with PCI resulted in excellent early and midterm outcomes. In experienced hands, the robotic endoscopic approach allows the routine use of multiple arterial grafting during HCR.
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Affiliation(s)
- Sarah M Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL USA
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL USA
| | | | - Sandeep Nathan
- Department of Cardiology, University of Chicago Medicine, IL USA
| | - Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, IL USA
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Claessens J, Yilmaz A, Awouters C, Oosterbos H, Thonnisen S, Benit E, Kaya A, Bataille Y. Clinical results after hybrid coronary revascularization with totally endoscopic coronary surgery. J Cardiothorac Surg 2022; 17:98. [PMID: 35505359 PMCID: PMC9062863 DOI: 10.1186/s13019-022-01840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background The optimal revascularization strategy remains uncertain in multivessel coronary artery disease (MVCAD). The durability of the surgical grafts should be weighed against the decreased invasiveness of percutaneous coronary intervention (PCI). Hybrid coronary revascularization (HCR), a combination of PCI and surgery, could be a feasible alternative. This study aimed to investigate the occurrence of major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality after both endoscopic coronary artery bypass grafting (Endo-CABG) and the HCR procedure. Methods In this single-center retrospective observational study, 347 consecutive patients have been subjected to an Endo-CABG procedure, of which 103 underwent HCR between January 2016 and January 2018. A propensity score matching analysis was performed to match 103 Endo-CABG alone patients to the 103 HCR patients. The Endo-CABG procedure was performed through 3 endoscopic ports (5 mm) in the 2nd, 3rd, and 4th intercostal space and a utility port of 3 cm. Results In both the HCR and matched endo-CABG alone group, the 30-day mortality was acceptable (0% in the HCR group and 1.94% in the matched Endo-CABG alone group, p = 0.155). Additionally, the occurrence of MACCE after a mean follow-up of 1188 ± 538 days was similar in both groups (9.71% and 11.65% for the HCR and matched Endo-CABG alone group, respectively, p = 0.652). Still, the long-term all-cause mortality over this period was significantly higher in the matched Endo-CABG alone group (2.91% after the HCR procedure and 11.65% after matched Endo-CABG alone, p = 0.002). Conclusion HCR has some advantages over Endo-CABG alone regarding the all-cause mortality, cross-clamping time, intensive care unit, and hospital length of stay. Therefore, HCR may be a suitable alternative therapy for patients with MVCAD.
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Affiliation(s)
- Jade Claessens
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium. .,Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, Hasselt, Belgium.
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Camille Awouters
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Hanne Oosterbos
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Stef Thonnisen
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, Hasselt, Belgium
| | - Yoann Bataille
- Department of Cardiology, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
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Van Praet KM, Kofler M, Shafti TZN, El Al AA, van Kampen A, Amabile A, Torregrossa G, Kempfert J, Falk V, Balkhy HH, Jacobs S. Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature. ACTA ACUST UNITED AC 2021; 16:e08. [PMID: 34295373 PMCID: PMC8287382 DOI: 10.15420/icr.2021.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/29/2021] [Indexed: 12/21/2022]
Abstract
Minimally invasive coronary revascularisation was originally developed in the mid 1990s as minimally invasive direct coronary artery bypass (MIDCAB) grafting is a less invasive approach compared to conventional coronary artery bypass grafting (CABG) to address targets in the left anterior descending coronary artery (LAD). Since then, MIDCAB has evolved with the adoption of a robotic platform and the possibility to perform multivessel bypass procedures. Minimally invasive coronary revascularisation surgery also allows for a combination between the benefits of CABG and percutaneous coronary interventions for non-LAD lesions – a hybrid approach. Hybrid coronary revascularisation results in fewer blood transfusions, shorter hospital stay, decreased ventilation times and patients return to work sooner when compared to conventional CABG. This article reviews the available literature, describes standard approaches and considers topics, such as limited access procedures, indications and patient selection, diagnostics and imaging, techniques, anastomotic devices, hybrid coronary revascularisation and outcome analysis.
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Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| | - Timo Z Nazari Shafti
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Berlin Institute of Health Berlin, Germany
| | - Alaa Abd El Al
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| | - Antonia van Kampen
- ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Leipzig Heart Center, University Clinic for Cardiac Surgery Leipzig, Germany
| | - Andrea Amabile
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Gianluca Torregrossa
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Berlin Institute of Health Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin Berlin, Germany.,Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zurich, Switzerland
| | - Husam H Balkhy
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
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Multivessel coronary artery revascularization through left mini-anterior thoracotomy. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:557-559. [PMID: 32953225 DOI: 10.5606/tgkdc.dergisi.2020.19279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022]
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Balkhy HH, Kitahara H, Hirai T, Matsukage H, Nathan S. Residual SYNTAX Score After Advanced Hybrid Robotic Totally Endoscopic Coronary Revascularization. Ann Thorac Surg 2020; 109:1826-1832. [DOI: 10.1016/j.athoracsur.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/18/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
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Balkhy HH, Kitahara H, Mitzman B, Nisivaco S. Robotic totally endoscopic beating-heart bypass to the right coronary artery: first worldwide experience. Eur J Cardiothorac Surg 2020; 57:529-534. [PMID: 31638696 DOI: 10.1093/ejcts/ezz283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/29/2019] [Accepted: 09/20/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Left coronary vessels are the usual targets in totally endoscopic coronary artery bypass (TECAB). Grafting of the right coronary artery (RCA) has been limited using this approach because of anatomic and technical difficulties. We report a first series of robotic beating-heart TECAB to the RCA via a right-chest approach. METHODS From July 2013 to April 2019, patients who underwent robotic beating-heart TECAB with the right internal mammary artery to the RCA were reviewed. Port placement in the right chest mirrored standard left-sided ports. Indications for right internal mammary artery to RCA bypass were RCA disease not amenable to percutaneous intervention and anomalous origin of the RCA. RESULTS Right internal mammary artery-RCA bypass was performed in 16 patients (mean age 60.6 ± 13.5, 75% male). All cases were completed without conversion to sternotomy or mini-thoracotomy. Cardiopulmonary bypass was required in 1 patient to expose the posterior descending artery. Mean procedure time was 223 ± 49 min, with half of the patients extubated in the operating room (50%). Mean intraoperative transit-time graft flow was 87.0 ± 19.3 ml/min, and a pulsatility index of 1.2 ± 0.2. Mean length of stay was 2.3 ± 1.2 days. No mortality was observed at mean follow-up time of 20.6 months. One patient required repeat RCA revascularization for progression of native disease 43.7 months after the surgery. CONCLUSIONS Robotic beating-heart TECAB for isolated RCA disease is a feasible operation in selected patients. This technique is possible even for the posterior descending artery.
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Affiliation(s)
- Husam H Balkhy
- Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Hiroto Kitahara
- Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Brian Mitzman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, USA
| | - Sarah Nisivaco
- Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
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Robotic Multivessel Endoscopic Coronary Bypass: Impact of a Beating-Heart Approach With Connectors. Ann Thorac Surg 2019; 108:67-73. [DOI: 10.1016/j.athoracsur.2018.12.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/17/2018] [Accepted: 12/17/2018] [Indexed: 11/19/2022]
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12
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Kitahara H, Hirai T, McCrorey M, Patel B, Nisivaco S, Nathan S, Balkhy HH. Hybrid coronary revascularization: Midterm outcomes of robotic multivessel bypass and percutaneous interventions. J Thorac Cardiovasc Surg 2019; 157:1829-1836.e1. [DOI: 10.1016/j.jtcvs.2018.08.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/29/2018] [Accepted: 08/13/2018] [Indexed: 10/27/2022]
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13
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The narrow field of view: challenges in sustaining a robotic open-heart program. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-018-0656-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:363-369. [PMID: 29028652 DOI: 10.1097/imi.0000000000000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We describe our original dry-lab training system for nonrobotic and beating heart endoscopic coronary artery anastomosis. METHODS All the materials used for this training were commercially available. We selected a boxed machine, which can produce pulsatile movements of artificial vessels, and on its roof, we installed a two-dimensional home video camera and a monitor. A multiple-holed plate was placed in front of the machine, and through these holes, a trainee inserted endoscopic surgical instruments and anastomosed the artificial vessels by running fashion while watching the monitor. This training program has four stages. During the first stage, a trainee has to demonstrate mastery in conducting a conventional off-pump coronary artery anastomosis without assistance. The second stage is the "nonbeating" version, and the third stage is the "beating" version with the model mentioned previously. After a trainee gets accustomed to the third stage, the original artificial vessel is replaced with an extremely fragile one, and this is the fourth stage. Our trainee conducted one hundred fourth-stage anastomoses and each procedure was recorded with the video camera. We analyzed several factors from the videos and evaluated the efficacy of the training method. We compared the outcomes of the first 50 consecutive anastomoses with the following 50 ones and described the learning curves. RESULTS The comparison showed a significant decrease in anastomotic time and vessel injury. We considered the quality of anastomosis acceptable after 47 anastomoses, and anastomotic time fell below 15 minutes at the 81st training at the fourth stage. CONCLUSIONS Our dry-lab system might be an effective training method for endoscopic coronary anastomosis.
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Ujihira K, Yamada A. Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kosuke Ujihira
- From the Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Akira Yamada
- From the Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan
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Minimally invasive surgical techniques in the era of hybrid coronary revascularization: additional benefits for the elderly patients? JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:875-879. [PMID: 27928232 PMCID: PMC5131205 DOI: 10.11909/j.issn.1671-5411.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kayatta MO, Halkos ME. Reviewing hybrid coronary revascularization: challenges, controversies and opportunities. Expert Rev Cardiovasc Ther 2016; 14:821-30. [PMID: 27042753 DOI: 10.1080/14779072.2016.1174576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Two main approaches to myocardial revascularization currently exist, coronary artery bypass and percutaneous coronary intervention. In patients with advanced coronary artery disease, coronary artery bypass surgery is associated with improved long term outcomes while percutaneous coronary intervention is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach. This new approach, hybrid coronary revascularization, has shown encouraging early results. Minimally invasive techniques for bypass surgery have played a large part of bringing this approach into contemporary practice.
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Affiliation(s)
- Michael O Kayatta
- a Division of Cardiothoracic Surgery , Emory University School of Medicine , Atlanta , GA , USA
| | - Michael E Halkos
- a Division of Cardiothoracic Surgery , Emory University School of Medicine , Atlanta , GA , USA
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