1
|
He P, Yang Y, Song Y, Yuan Y, Wu W, Liu C, Hu Y. Osteophyte of the first costochondral joint is a reliable landmark to facilitate standardized robotic left internal mammary artery harvesting. JTCVS Tech 2025; 29:56-64. [PMID: 39991316 PMCID: PMC11845373 DOI: 10.1016/j.xjtc.2024.11.004] [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: 07/31/2024] [Revised: 10/15/2024] [Accepted: 11/09/2024] [Indexed: 02/25/2025] Open
Abstract
Objective Robotic left internal mammary artery (LIMA) harvesting can present various challenges for novice surgeons. This study aimed to investigate whether the osteophyte of the first costochondral joint (OFCCJ) could serve as an anatomical landmark for robotic LIMA harvesting and to explore the optimal standardized process. Methods The concept of "LIMA isthmus" was described on the basis of relatively fixed anatomical relationship between LIMA and OFCCJ, and the height of OFCCJ and its distance to LIMA were defined. The presence and features of OFCCJ were analyzed in 514 hospitalized patients with or without coronary artery diseases (CAD or non-CAD). The value of "LIMA isthmus"-based robotic harvesting strategy was further assessed for beginners during the learning curve phase. Results The OFCCJs were found to be very common in the adult population. The prevalence of OFCCJ in patients with CAD was significantly greater than in patients without CAD (73.16% vs 60.33%, P < .01). However, there were no significant difference between the CAD and the non-CAD group in the height of the OFCCJ or the distance between the OFCCJ and the LIMA (15.54 ± 4.99 mm vs 16.55 ± 4.70 mm, P = .06; 12.66 ± 4.19 mm vs 12.45 ± 6.87 mm, P = .72). During the learning curve phase, the time to identify LIMA and the time for LIMA harvesting using "LIMA isthmus"-based strategy were significantly shorter than those with conventional approach (89.00 ± 31.07 seconds vs 1087 ± 436.1 seconds, P = .035; 86.80 ± 4.74 minutes vs 110.5 ± 11.72 minutes, P = .013). The inadvertent bleeding events with "LIMA isthmus"-based graft harvesting were much fewer (1.00 ± 0.19 vs 3.44 ± 0.34, P < .001), although there was no difference between 2 beginners in postoperative chest drainage, LIMA injury events, or conversion to a median sternotomy incision. Conclusions OFCCJ could serve as a reliable anatomical landmark to guide robotic LIMA harvesting. "LIMA isthmus"-based standardized robotic LIMA harvesting could significantly reduce the time to determine LIMA and the time for graft harvesting process, and minimize the risk of inadvertent bleeding events. This could be particularly beneficial for novice surgeons during the initial learning curve phase of this procedure.
Collapse
Affiliation(s)
- Peiling He
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yan Yang
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Song
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Ye Yuan
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Wenjun Wu
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Chang Liu
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yijie Hu
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, China
| |
Collapse
|
2
|
Güner A, Can C, Bedir FF, Aydin Ü, Kadiroğullari E, Akman C, Gültekin Güner E, Aydin E, Serter B, Çizgici AY, Aktürk İF, İyigün T, Aksu T, Doğan A, Aydin M, Şimşek A, Uzun F. Comparison of long-term outcomes of minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for left main disease. Coron Artery Dis 2025:00019501-990000000-00337. [PMID: 39836499 DOI: 10.1097/mca.0000000000001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
Abstract
BACKGROUND Minimally invasive coronary artery bypass grafting (MICS-CABG) is frequently used for coronary revascularization, but the comparison of long-term clinical results with percutaneous coronary intervention (PCI) in left main disease (LMDs) remains unclear. The present study sought to determine the long-term outcomes of MICS-CABG and PCI in patients with LMDs. METHODS A total of 551 consecutive patients [man: 457 (82.9%), mean age: 60.70 ± 9.54 years] who underwent PCI or MICS-CABG for LMDs were included. The primary endpoint was defined as the all-cause death during follow-up. The secondary endpoint defined as the major cardiovascular and cerebral events (MACCE) included cardiac death, myocardial infarction, target vessel revascularization, stroke, and stent thrombosis or graft occlusion. Inverse probability weighting (IPW) was performed to reduce treatment selection bias. This is the first report comparing the long-term outcomes of MICS-CABG and PCI in patients with LMDs. RESULTS The initial revascularization strategy was MICS-CABG in 269 (48.8%) cases and PCI in 282 (51.2%) patients. The SYNTAX scores (31.25 ± 4.63 vs. 26.05 ± 5.9, P < 0.001) were notably higher in the MICS-CABG group than in the PCI group. The incidence of long-term mortality (11 vs. 5.6%, P = 0.022) and MACCE (22 vs. 15.2%, P = 0.042) were notably higher in the PCI group than in the MICS-CABG group. The long-term mortality [adjusted HR (IPW) = 6.38 (95% CI, 3.00-13.57), P < 0.001] and MACCE [adjusted HR (IPW) = 4.51 (95% CI, 2.90-7.03), P < 0.001] in the overall population significantly differed between the PCI group and the MICS-CABG group. CONCLUSION The present study suggests that MICS-CABG for LMDs was associated with lower long-term mortality and MACCE rates than PCI.
Collapse
Affiliation(s)
- Ahmet Güner
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Cemil Can
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Fatih Furkan Bedir
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Ünal Aydin
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ersin Kadiroğullari
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cemalettin Akman
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Ezgi Gültekin Güner
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Emre Aydin
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Berkay Serter
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Ahmet Yaşar Çizgici
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - İbrahim Faruk Aktürk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Taner İyigün
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Timuçin Aksu
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Doğan
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Merve Aydin
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Aybüke Şimşek
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Fatih Uzun
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| |
Collapse
|
3
|
Winter M, Rubino TE, Miller D, Yun G, Dufendach K, Hess N, Yousef S, Chan E, Bianchini VG, Thorngren C, Murray H, Waterford S, Kaczorowski D, Sultan I, Bonatti J. Subcutaneous emphysema in patients undergoing robotic cardiac surgery: risk factors and clinical outcome. J Robot Surg 2024; 18:395. [PMID: 39499434 DOI: 10.1007/s11701-024-02112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 09/20/2024] [Indexed: 11/07/2024]
Abstract
Little is known about the incidence of subcutaneous emphysema (SE) after robotic cardiac surgery. The aim of this study was to describe the incidence, identify risk factors, and assess its influence on postoperative outcomes. Patients undergoing robotic mitral valve repair (n = 63, 54.3%), robotic minimally invasive direct coronary artery bypass grafting (n = 23, 19.8%), and robotic totally endoscopic coronary artery bypass grafting (n = 30,25.9%) were included in the analysis (total n = 116). Subcutaneous emphysema occurred in 53/116 patients (45.7%). It was mild in 30/53 patients (56.6%), moderate in one patient (1.9%), and severe in 22/53 patients (41.5%). Low body weight (p = 0.009), low BMI (p = 0.006), small body surface area (p = 0.01), and older age (p = 0.041) significantly correlated with SE. Patients undergoing robotic mitral valve repair were affected more often than patients undergoing robotic coronary artery bypass grafting (p = 0.04). Severe subcutaneous emphysema resulted in an increased need for CT-chest imaging (p = 0.026), and additional chest tubes (p = 0.029). Severe emphysema was highly associated with pneumothorax (p < 0.001) and increased duration of chest tube drainage (p = 0.003). Subcutaneous emphysema after robotic heart surgery occurs preferentially in patients with low body weight, low BMI, a small body surface area, and older age and is more common in robotic MVR than in robotic coronary artery bypass surgery. It leads to an increased need for thoracic imaging and additional chest tube insertion. Clinical outcomes are not affected.
Collapse
Affiliation(s)
- Martin Winter
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Thomas E Rubino
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Danielle Miller
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Gabin Yun
- Department of Radiology, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Keith Dufendach
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Nicholas Hess
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Sarah Yousef
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Ernest Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Veronica Garvia Bianchini
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Christina Thorngren
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Holt Murray
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Stephen Waterford
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - David Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA.
| |
Collapse
|
4
|
Berger T, Fagu A, Czerny M, Hartikainen T, Von Zur Mühlen C, Kueri S, Eschenhagen M, Kreibich M, Beyersdorf F, Rylski B. Intraoperative Invasive Coronary Angiography after Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg 2024. [PMID: 39496296 DOI: 10.1055/s-0044-1791960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2024]
Abstract
OBJECTIVE The aim of this study was to prospectively evaluate the feasibility and safety of intraoperative invasive coronary angiography (ICA) following coronary artery bypass grafting using a mobile angiography C-arm. METHODS Between August 2020 and December 2021, 18 patients were enrolled for intraoperative ICA following coronary artery bypass grafting. After skin closure, ICA was performed including angiography of all established bypass grafts via a mobile angiography system by an interventional cardiologist. Data on graft patency, stenosis, and kinking were assessed. Grafts were rated on an ordinal scale ranging from very poor (1) to excellent (5). Furthermore, the impact of ICA compared with flow measurement was assessed using the ordinal Likert scale ranging from (I) worse to (V) much better. RESULTS The ICA was considered better (V) compared with transient flow measurement in 38 (93%) and comparable (III) in 3 (7%) distal anastomoses. ICA impacted clinical or surgical decision-making in three patients (17%). In one patient, dual antiplatelet therapy for 6 months was initiated and rethoracotomy was needed in two (11%) patients with bypass graft revision and additional bypass grafting for graft occlusion. There were no cerebral and distal embolic events or access vessel complications observed and no postoperative acute kidney injury occurred. CONCLUSION Intraoperative angiography after coronary bypass grafting is safe. Using a mobile angiographic device, graft patency, and function assessment was superior to transit time flow measurement leading to further consequences in a relevant number of patients. Therefore, it has the potential to reduce postoperative myocardial injury and improve survival.
Collapse
Affiliation(s)
- Tim Berger
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
- University of Freiburg, Freiburg, Germany
| | - Albi Fagu
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
- University of Freiburg, Freiburg, Germany
- Department of Cardiac Surgery, Spitali Universitar"Shefqet Ndroqi", Tirana, Albania
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
- University of Freiburg, Freiburg, Germany
| | - Tau Hartikainen
- University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
| | - Constantin Von Zur Mühlen
- University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
| | - Sami Kueri
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
- University of Freiburg, Freiburg, Germany
| | - Matthias Eschenhagen
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
- University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
- University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
- University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center, University Medical Center Freiburg, Freiburg, Germany
- University of Freiburg, Freiburg, Germany
| |
Collapse
|
5
|
Hwang B, Ren J, Wang K, Williams ML, Yan TD. Systematic review and meta-analysis of two decades of reported outcomes for robotic coronary artery bypass grafting. Ann Cardiothorac Surg 2024; 13:311-325. [PMID: 39157187 PMCID: PMC11327407 DOI: 10.21037/acs-2023-rcabg-0191] [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: 11/20/2023] [Accepted: 04/23/2024] [Indexed: 08/20/2024]
Abstract
Background Despite the well-documented safety and feasibility of robotic coronary artery bypass grafting (CABG), widespread adoption of this approach remains limited by its steep learning curve, high procedural costs and paucity of data on longer-term efficacy. This current meta-analysis aims to provide a systematic overview of the outcomes of robot-assisted CABG, with a focus on long term graft patency and freedom from major adverse cardiac and cerebrovascular events (MACCE). Methods A systematic literature search of three electronic databases was conducted for studies reporting outcomes of robotic-assisted CABG, and were grouped based on whether patients underwent robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB), totally endoscopic coronary artery bypass (TECAB) or were mixed. Perioperative and mid-to-long term results from included studies were pooled using meta-analysis of proportion or means in a random effects model. Results In the quantitative analysis, thirty-nine eligible studies included 6,152 patients who underwent RA-MIDCAB, 1,729 patients who underwent TECAB and 21,642 patients who underwent either form of robot-assisted CABG. A high level of heterogeneity was observed amongst baseline characteristics. Perioperative mortality and complication rates were low. Conversion rate to full sternotomy overall was less than 3.2% [95% confidence interval (CI): 2.1-5.2%, I2=39%]. At a mean follow-up duration of 5.2 years, overall graft patency was 96% for both RA-MIDCAB and TECAB, and freedom from major adverse cardiac events (MACE) or MACCE was 83.2% (95% CI: 72.0-90.4%; I2=90%) for RA-MIDCAB and 91.6% (95% CI: 86.6-94.9%; I2=76%) for TECAB. Conclusions Robot-assisted CABG is observed to have acceptable perioperative and mid-to-long term outcomes with promising overall graft patency.
Collapse
Affiliation(s)
- Bridget Hwang
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Justin Ren
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Katherine Wang
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael L. Williams
- Department of Cardiothoracic Surgery, St Vincent’s Hospital, Sydney, NSW, Australia
| | - Tristan D. Yan
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
6
|
Jinghui L, Yin Y, Xiaokaitijiang M, Yipeng T, Lianqun W, Yunpeng B, Zhejun Z, Nan J, Qiang W, Qingliang C, Dong X, Dongyan Y, Zhigang G, Feng Z. Comparison of clinical effects of coronary artery bypass grafting between left anterior small thoracotomy approach and lower-end sternal splitting approach. J Int Med Res 2024; 52:3000605241247656. [PMID: 38818531 PMCID: PMC11143834 DOI: 10.1177/03000605241247656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 03/28/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE To compare the clinical effects of coronary artery bypass grafting (CABG) between the left anterior small thoracotomy (LAST) and lower-end sternal splitting (LESS) approaches for coronary artery disease. METHODS In total, 110 patients who underwent LAST from October 2015 to December 2020 in Tianjin Chest Hospital were selected as the observation group. Patients who underwent the LESS approach during the same period were analyzed. The propensity score was calculated by a logistic regression model, and nearest-neighbor matching was used for 1:1 matching. RESULTS The length of hospital stay and ventilator support time were significantly shorter in the LAST than LESS group. The target vessels in the obtuse marginal branch and posterior left ventricular artery branch grafts were significantly more numerous in the LAST than LESS group, but those in the right coronary artery graft were significantly less numerous in the LAST group. CONCLUSIONS CABG using either the LAST or LESS approach is safe and effective, especially in low-risk patients. The LAST approach can achieve complete revascularization for multivessel lesions and has the advantages of less trauma and an aesthetic outcome. However, it requires a certain learning curve to master the surgical techniques and has specific surgical indications.
Collapse
Affiliation(s)
- Li Jinghui
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
- Clinical College of Thoracic Medicine, Tianjin Medical University, Tianjin, P.R. China
| | - Yang Yin
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
- Clinical College of Thoracic Medicine, Tianjin Medical University, Tianjin, P.R. China
| | | | - Tang Yipeng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Wang Lianqun
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Bai Yunpeng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Zhang Zhejun
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Jiang Nan
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Wang Qiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Chen Qingliang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Xu Dong
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Yang Dongyan
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Guo Zhigang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Zhao Feng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| |
Collapse
|
7
|
Giroletti L, Graniero A, Agnino A. Robotic-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting: A Surgical Technique. J Clin Med 2024; 13:2435. [PMID: 38673708 PMCID: PMC11051288 DOI: 10.3390/jcm13082435] [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: 03/16/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
In recent years, there has been a growing interest in robotic-assisted coronary artery revascularization in Europe. Two different types of surgery can be performed using a robotic platform: RA-MIDCAB, in which the mammary artery is harvested endoscopically with robotic assistance and off-pump bypass graft is achieved under direct vision through mini thoracotomy, and TE-CAB, completely robotically performed. We started the robotic cardiac surgery program for mitral valve disease in our hospital, Humanitas Gavazzeni (Bergamo, Italy), in 2019; and in 2021, we addressed our experience with RA-MIDCAB. After a learning curve period, we have developed our technique to optimize the benefits offered by the robotic platform, tailoring strategy to individual patients, based on preoperative radiological images.
Collapse
Affiliation(s)
- Laura Giroletti
- Department of Cardiovascular Surgery, Division of Robotic and Minimally-Invasive Cardiac Surgery, Humanitas Gavazzeni-Castelli, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | | | | |
Collapse
|
8
|
Yusuf MM, Bansal V, Gunasekaran S, Kaliyamoorthy D, Kumar AM. Total arterial revascularization using robot assisted minimally invasive coronary artery bypass: an Indian experience. Indian J Thorac Cardiovasc Surg 2024; 40:42-49. [PMID: 38125327 PMCID: PMC10728025 DOI: 10.1007/s12055-023-01593-6] [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: 03/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 12/23/2023] Open
Abstract
Objective The aim of this study is to analyze the early outcomes of Total Arterial Revascularization using Robot Assisted Minimally Invasive Coronary Artery Bypass at our center between June 2019 and January 2023. Methods This is a retrospective analysis of 195 patients who underwent Total Arterial Coronary Revascularization through Robot Assisted Minimally Invasive Coronary Artery Bypass procedure (RA-CABG) during the period of June 2019 and January 2023 in a quaternary care center in India. Primary outcome variables were in-hospital and 30-day mortality. Secondary outcome variables included duration of surgery, length of intensive care unit (ICU) stay, in-hospital stay and perioperative morbidity. The entire patient population was divided into two groups for a subgroup analysis based on when the surgery was conducted i.e. the years since the robotic program was begun at our institution with 81 patients in group I (2019-2021), and 114 patients in group II (2022-2023). Results 195 patients [88.7% male, mean age of 61.34 ± 9.58 years] underwent RA-CABG during the 5-year period (2019-2023) by a single experienced surgeon and his team. Conversion to larger thoracic incisions was required in 5 cases (2.59%). In-hospital and 30-day mortality was 1.02% each. The average length of ICU stay and hospital stay were 2.82 ± 1.17 days and 5.84 ± 1.71 days respectively. The duration of ICU stay correlated with the number of internal mammary artery grafts procured (p = 0.0022). Median duration of follow-up was 11 months. Overall mortality was 3.62% and cardiac related mortality was 2.07%, and 5 patients (2.59%) underwent percutaneous coronary intervention. Results of the sub-group analysis revealed a statistically significant difference between the groups in terms of number of internal mammary artery grafts procured (p = 0.010), need for transfusions (p = 0.00031), ICU stay (p = 0.0005) and in-hospital stay (p = 0.0006). Conclusions Total Arterial Coronary Revascularization through RA-CABG is a viable procedure in select patients. An experienced surgeon and team are required. Further studies in the form of randomized trials with long term follow-up are required to establish the overall utility, effectiveness and benefits to the patients.
Collapse
Affiliation(s)
| | - Varun Bansal
- Apollo Heart Institute, Indraprastha Apollo Hospital, Mathura Road, New Delhi, 110076 India
| | | | | | - Aishwarya Mahesh Kumar
- Apollo Heart Institute, Apollo Hospitals, Greams Road, Chennai, 600006 India
- Department of Medical Services, Apollo Hospital, Greams Road, Chennai, India
| |
Collapse
|
9
|
Piperata A, Busuttil O, Jansens JL, Modine T, Pernot M, Labrousse L. A Single Center Initial Experience with Robotic-Assisted Minimally Invasive Coronary Artery Bypass Surgery (RA-MIDCAB). J Pers Med 2022; 12:1895. [PMID: 36422071 PMCID: PMC9694867 DOI: 10.3390/jpm12111895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Minimally invasive procedures have demonstrated their effectiveness in reducing the recovery times while ensuring optimal results and minimizing complications. Regarding the coronary artery surgical revascularization field, the evolution of techniques and technology is permitting new surgical strategies that are increasingly precise and suitable for each patient. We present an initial single center experience with a case series of patients successfully treated with combined robotic harvesting of the left internal mammary artery (LIMA) and minimally invasive direct coronary artery bypass graft (MIDCAB) for the anastomosis. METHODS We retrospectively reviewed the records of patients who underwent minimally invasive coronary artery revascularization with the use of two combined techniques at our Institution between January 2021 and October 2022. RESULTS A total of 17 patients underwent coronary artery bypass grafting with the described approach. The median cardiopulmonary bypass (CPB) and cross-clamp times were 83 min (76-115) and 38 min (32-58), respectively. The median intensive care unit (ICU) and hospital stay were 2 days (1-4) and 8 days (6-11), respectively. The procedure's success was achieved in 100% of patients. The 30-day mortality was 0%. CONCLUSIONS Considering all the limitations related to the small sample, the presented results of a hybrid approach for minimally invasive coronary artery bypass grafting (CABG) appears to be encouraging and acceptable. The main advantage of this approach is related to the reduction of postoperative pain and pulmonary complications.
Collapse
Affiliation(s)
- Antonio Piperata
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Jean-Luc Jansens
- Department of Cardiac Surgery, Erasme Hospital of Brussels, Belgium free University of Brussels (ULB), Hôpital Erasme, 1070 Brussels, Belgium
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Louis Labrousse
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| |
Collapse
|