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Willard R, Scheinerman J, Pupovac S, Patel NC. The Current State of Hybrid Coronary Revascularization. Ann Thorac Surg 2024; 118:318-328. [PMID: 38677447 DOI: 10.1016/j.athoracsur.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/15/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024]
Abstract
Hybrid coronary revascularization (HCR) combines a minimally invasive surgical approach with percutaneous coronary intervention (PCI) for the treatment of multivessel coronary artery disease. Despite decades of use, widespread acceptance has been limited. In this review, we conduct a comparative assessment of HCR in relation to traditional coronary artery bypass graft surgery and multivessel PCI. Although large-scale randomized data are still lacking, numerous studies have demonstrated that HCR may offer benefits regarding resource utilization and short-term morbidity while delivering comparable mid- and long-term survival compared with traditional bypass surgery. Compared with PCI, HCR may offer similar periprocedural morbidity while mitigating the need for repeat revascularization by providing a surgical arterial bypass graft to the left anterior descending artery.
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Affiliation(s)
- Robin Willard
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Joshua Scheinerman
- Department of Cardiothoracic Surgery, New York University Grossman School of Medicine, New York, New York
| | - Stevan Pupovac
- Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital/Northwell Health, New York, New York
| | - Nirav C Patel
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York.
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Hoogewerf M, Schuurkamp J, Kelder JC, Jacobs S, Doevendans PA. Sutureless versus Hand-Sewn Coronary Anastomoses: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11030749. [PMID: 35160201 PMCID: PMC8837108 DOI: 10.3390/jcm11030749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Sutureless coronary anastomotic devices are intended to facilitate minimally invasive coronary artery bypass grafting (MICS-CABG) by easing and eventually standardizing the anastomotic technique. Within this systematic review and meta-analysis, we aim to determine patency and to evaluate safety outcomes for the sutureless anastomoses. Methods: CENTRAL, MEDLINE, and EMBASE were searched from database start till August 2021 in a predefined search strategy combining the key concepts: ‘coronary artery bypass grafting’, ‘sutureless coronary anastomoses’, and ‘hand-sewn coronary anastomoses’ by the Boolean operation ‘AND’. Study characteristics, patient demographics, interventional details, and all available outcome data were extracted. A meta-analysis was performed on patency at longest follow-up. Safety outcomes were presented. Results: A total of eleven trials towards six sutureless anastomotic devices were included, comprising 3724 patients (490 sutureless and 3234 hand-sewn). There was no significant difference in patency at a mean follow-up duration of 546.3 (range 1.5–2691) days, with a risk ratio of 0.77 (95% CI 0.55–1.06). MACE was reported in 4.5% sutureless and 3.9% hand-sewn patients, including all-cause mortality (resp. 1.3 vs. 1.9%), myocardial infarction (resp. 1.6 vs. 1.7%), and coronary revascularization (resp. 1.8 vs. 0.5%). Incomplete hemostasis occurred in 24.8% of the sutureless anastomoses. Intra-operative device failure forced conversion to hand-sewn or redo-anastomosis in 5.8% of the sutureless cases. Conclusion: Based on the systematic review and meta-analysis including six devices, we conclude that sutureless coronary anastomotic devices appear safe and effective when used by well-trained and dedicated surgical teams.
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Affiliation(s)
- Marieke Hoogewerf
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.); (P.A.D.)
- Department of Cardiothoracic Surgery, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Correspondence:
| | - Jeroen Schuurkamp
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.); (P.A.D.)
| | - Johannes C. Kelder
- Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, 13353 Berlin, Germany;
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.); (P.A.D.)
- Netherlands Heart Institute, 3511 EP Utrecht, The Netherlands
- Central Military Hospital, 3584 EZ Utrecht, The Netherlands
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Balkhy HH, Nisivaco SM, Hashimoto M, Torregrossa G, Grady K. Robotic Total Endoscopic Coronary Bypass in 570 Patients: Impact of Anastomotic Technique in 2 Eras. Ann Thorac Surg 2021; 114:476-482. [PMID: 34890572 DOI: 10.1016/j.athoracsur.2021.10.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND In coronary bypass grafting, including robotic off-pump totally-endoscopic coronary bypass (TECAB), the anastomotic technique is the most critical part of the procedure. We reviewed results in 570 patients over a 7-year period and compared outcomes between to eras, based on predominant anastomotic technique: connectors versus running suture. METHODS Between 7/2013-12/2020, 570 patients underwent off-pump TECAB. Group-1 (378 patients, 7/2013-8/2018) using predominantly the C-Port Flex ATM distal anastomotic stapler (Aesculap, Tuttlingen Germany), Group-2 (192 patients, 9/2018-12/2020) using predominantly a sutured technique (7-0 PronovaTM, Johnson and Johnson, USA). Retrospective analysis of clinical outcomes was performed. RESULTS Off-pump TECAB was completed in 98.8% (563/570 patients) with an Observed/Expected mortality of 0.6 (6/570 patients). The anastomotic device was used in 89% of 626 grafts in Group-1 and only 11% of 305 grafts in Group-2 (p=0.001). There were no differences in multivessel TECAB (57%vs.53%;p=0.331) or bilateral internal thoracic artery use (50%vs.43%;p=0.127) in Group-1 vs Group-2, respectively. Operative time was shorter in Group-1 (242+84 min vs. 273+88 min;p<0.001). Early clinical outcomes were similar between groups, except for hospital stay which was longer in Group-1 (2.9vs2.3 days;p<0.001). Graft patency was similar (98%vs95%;p=0.295) in Group-1 vs Group-2, respectively. CONCLUSIONS Changing the predominant approach from stapled anastomosis to a sutured technique during robotic TECAB resulted in longer operative times. Both approaches led to excellent outcomes, including graft patency. The shorter operative times conferred by using staplers may flatten the learning curve and facilitate broader adoption of TECAB.
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Affiliation(s)
- Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois.
| | - Sarah M Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Makoto Hashimoto
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kaitlin Grady
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
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Balkhy HH. Robotic totally endoscopic coronary artery bypass grafting: It's now or never! JTCVS Tech 2021; 10:153-157. [PMID: 34977718 PMCID: PMC8690331 DOI: 10.1016/j.xjtc.2021.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Husam H. Balkhy
- Address for reprints: Husam H. Balkhy, MD, FACS, FACC, Section of Cardiac Surgery, University of Chicago, 5841 S Maryland Ave, E-500, Chicago, IL 60637.
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Weiss AJ, Frankel WC, Bakaeen FG. Commentary: Beyond the horizon of evidence in robotic totally endoscopic coronary artery bypass grafting. JTCVS Tech 2021; 10:160-161. [PMID: 34977720 PMCID: PMC8690279 DOI: 10.1016/j.xjtc.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aaron J. Weiss
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - William C. Frankel
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G. Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Balkhy HH, Nisivaco S, Kitahara H, Torregrossa G, Patel B, Grady K, Coleman C. Robotic off-pump totally endoscopic coronary artery bypass in the current era: report of 544 patients. Eur J Cardiothorac Surg 2021; 61:439-446. [PMID: 34392341 DOI: 10.1093/ejcts/ezab378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/27/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Robotic off-pump totally endoscopic coronary artery bypass (TECAB) is the least invasive form of surgical coronary revascularization. It has proved to be highly effective and safe. Its benefits are well-established and include fewer complications, shorter hospital stay and quicker return to normal activities. TECAB has undergone 2 decades of technological advancement to include multivessel grafting, a beating-heart approach and successful completion in multiple patient groups in experienced hands. The aim of this report was to examine outcomes of robotic off-pump TECAB at our institution over 7 years. METHODS Data from 544 patients undergoing TECAB between July 2013 and August 2020 were retrospectively examined. The C-Port Flex-A distal anastomotic device was used for the majority of grafts (70%). Yearly follow-up was conducted. Angiographic early patency data were reviewed for patients undergoing hybrid revascularization. RESULTS The mean age was 66 years, with 1.7% mean STS risk. Fifty-six percentage had multivessel TECAB. There was 1 conversion to sternotomy, and 46% extubation in the Operating Room (OR). Mortality was 0.9%. Early graft patency was 97%. At mid-term follow-up at 38 months, cardiac mortality was 2.7% and freedom from major adverse cardiac events was 92.5%. CONCLUSIONS We conclude that robotic beating-heart TECAB in the current era is safe and effective with excellent outcomes and comparable early angiographic patency to standard coronary artery bypass grafting surgery when performed frequently by an experienced team. This procedure was completed in our hands both with and without an anastomotic device. Longer-term studies are warranted.
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Affiliation(s)
- Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Sarah Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Brooke Patel
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kaitlin Grady
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Charocka Coleman
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, IL, USA
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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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Stecher D, Hoogewerf M, Bronkers G, van Putte BP, Doevendans PA, Tulleken CAF, van Herwerden L, Pasterkamp G, Buijsrogge MP. Preclinical Feasibility and Patency Analyses of a New Distal Coronary Connector: The ELANA Heart Bypass. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:163-168. [PMID: 33682510 PMCID: PMC8108114 DOI: 10.1177/1556984521991519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This preclinical study determines the feasibility and 6-month patency rates of a new distal coronary connector, the Excimer Laser Assisted Nonocclusive Anastomosis (ELANA) Heart Bypass. Methods Twenty Dutch Landrace pigs received either a hand-sewn (n = 8) or an ELANA (n = 12) left internal thoracic artery to left anterior descending artery anastomosis, using off-pump coronary artery bypass grafting. Six-month patency rates were demonstrated by coronary angiography and histological evaluation. Throughout, procedural details and complication rates were collected. Results The ELANA Heart Bypass demonstrated 0% mortality and complication rates during follow-up. It was demonstrated feasible, with comparable perioperative flow measurements (ELANA vs hand-sewn, median [min to max], 24 [14 to 28] vs 17 [12 to 31] mL/min; P = 0.601) and fast construction times (3 [3 to 7] vs 31 [26 to 37] min; P < 0.001). Yet, an extra hemostatic stitch was needed in 25% of the ELANA versus 12.5% of the hand-sewn anastomoses. The 6-month patency rate of the ELANA Heart Bypass was 83.3% versus 100% in hand-sewn anastomoses. The 2 occluded ELANA-anastomoses were defined model-based errors. Conclusions The ELANA Heart Bypass facilitates a sutureless distal coronary anastomosis. A design change is suggested to improve hemostasis and will be evaluated in future translational studies. This new technique is a potential alternative to hand-sewn anastomoses in (minimally invasive) coronary surgery.
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Affiliation(s)
- David Stecher
- 8124 Department of Cardiothoracic Surgery, University Medical Center Utrecht, The Netherlands
| | - Marieke Hoogewerf
- 8124 Department of Cardiology, University Medical Center Utrecht, The Netherlands.,AMT Medical Research B.V., Utrecht, The Netherlands
| | | | - Bart P van Putte
- 6028 Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiothoracic Surgery, Amsterdam University Medical Center, The Netherlands
| | - Pieter A Doevendans
- 8124 Department of Cardiology, University Medical Center Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Cornelis A F Tulleken
- AMT Medical Research B.V., Utrecht, The Netherlands.,8124 Department of Neurosurgery, University Medical Center Utrecht, The Netherlands
| | - Lex van Herwerden
- 8124 Department of Cardiothoracic Surgery, University Medical Center Utrecht, The Netherlands
| | - Gerard Pasterkamp
- 8124 Department of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
| | - Marc P Buijsrogge
- 8124 Department of Cardiothoracic Surgery, University Medical Center Utrecht, The Netherlands
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Balkhy HH, Nathan S, Torregrossa G, Kitahara H, Nisivaco S, McCrorey M, Patel B. Angiographic patency after robotic beating heart totally endoscopic coronary artery bypass grafting facilitated by automated distal anastomotic connectors. Interact Cardiovasc Thorac Surg 2020; 31:467-474. [PMID: 33091933 DOI: 10.1093/icvts/ivaa149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/17/2020] [Accepted: 07/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Robotic totally endoscopic coronary artery bypass (TECAB) on the beating heart has been facilitated in our experience using distal coronary anastomotic connectors. In this study, we retrospectively reviewed graft patency in all robotic TECAB patients who underwent formal angiography at our current institution over a 5-year period. METHODS Between July 2013 and June 2018, 361 consecutive patients underwent robotic beating-heart TECAB. Of these patients, 121 had a follow-up angiogram, which assessed graft patency. Eighty-four patients had an angiogram as part of planned hybrid procedures and 37 patients underwent an unplanned angiogram for clinical indications. Retrospective analysis of angiographic patency and clinical outcomes was performed. RESULTS The mean Society of Thoracic Surgeons predicted risk of mortality was 1.8%. Single-vessel bypass was performed in 40 (33%) patients and multivessel grafting in 81 (67%). Average flow (ml/min) and pulsatility index in the grafts was 74.7 ± 39.1 and 1.42 ± 0.52, respectively. The number of grafts evaluated was 204 (130 left internal mammary artery and 74 right internal mammary artery grafts). The median time to angiography was 1.0 and 16.0 months and graft patency was 98% and 91% in the hybrid and non-hybrid groups, respectively. Overall graft patency was 95.6% (left internal mammary artery = 96%; right internal mammary artery = 93%). Left internal mammary artery to left anterior descending artery graft patency was 97%. Clinical follow-up was available for 316 (88%) patients at mean 22.5 ± 15.1 months. Freedom from major adverse cardiac events at 2 years was 92%. CONCLUSIONS In this consecutive series of patients undergoing formal angiography after robotic single and multivessel TECAB, we found satisfactory graft patency and 2-year clinical outcomes. Longer-term follow-up is warranted.
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Affiliation(s)
- Husam H Balkhy
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Sandeep Nathan
- Division of Cardiology, Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Gianluca Torregrossa
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Hiroto Kitahara
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Sarah Nisivaco
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Mackenzie McCrorey
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Brooke Patel
- Section of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA
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Hashimoto M, Wehman B, Balkhy HH. Robotic totally endoscopic coronary artery bypass: Tips and tricks for using an anastomotic device. J Thorac Cardiovasc Surg 2019; 159:e57-e60. [PMID: 31653417 DOI: 10.1016/j.jtcvs.2019.08.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/04/2019] [Accepted: 08/13/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Makoto Hashimoto
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Brody Wehman
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Ill.
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Commentary: Of costs and compromises. J Thorac Cardiovasc Surg 2019; 159:e63-e64. [PMID: 31648837 DOI: 10.1016/j.jtcvs.2019.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
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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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