Is there an optimal minimally invasive technique for left anterior descending coronary artery bypass?

Abstract

BackgroundThe aim of this retrospective study was to evaluate the clinical outcome of three different minimally invasive surgical techniques for left anterior descending (LAD) coronary artery bypass grafting (CABG): Port-Access surgery (PA-CABG), minimally invasive direct CABG (MIDCAB) and off-pump totally endoscopic CABG (TECAB).MethodsOver a decade, 160 eligible patients for elective LAD bypass were referred to one of the three techniques: 48 PA-CABG, 53 MIDCAB and 59 TECAB. In MIDCAB group, Euroscore was higher and target vessel quality was worse. In TECAB group, early patency was systematically evaluated using coronary CT scan. During follow-up (mean 2.7 ± 0.1 years, cumulated 438 years) symptom-based angiography was performed.ResultsThere was no conversion from off-pump to on-pump procedure or to sternotomy approach. In TECAB group, there was one hospital cardiac death (1.7%), reoperation for bleeding was higher (8.5% vs 3.7% in MIDCAB and 2% in PA-CABG) and 3-month LAD reintervention was significantly higher (10% vs 1.8% in MIDCAB and 0% in PA-CABG). There was no difference between MIDCAB and PA-CABG groups. During follow-up, symptom-based angiography (n = 12) demonstrated a good patency of LAD bypass in all groups and 4 patients underwent a no LAD reintervention. At 3 years, there was no difference in survival; 3-year angina-free survival and reintervention-free survival were significantly lower in TECAB group (TECAB, 85 ± 12%, 88 ± 8%; MIDCAB, 100%, 98 ± 5%; PA-CABG, 94 ± 8%, 100%; respectively).ConclusionsOur study confirmed that minimally invasive LAD grafting was safe and effective. TECAB is associated with a higher rate of early bypass failure and reintervention. MIDCAB is still the most reliable surgical technique for isolated LAD grafting and the least cost effective.

Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency

“…The conversion and severe postoperative complication rate was lower in this study than reported elsewhere [8,9,18,20,21]. No death or conversion to median sternotomy occurred in either both the TECAB or MINICAB groups, and postoperative bleeding occurred in 1% of the TECAB group during the learning curve.…”

“…Although the early clinical results of robotic CABG were excellent with acceptable graft patency [19], the longer term graft patency and the freedom from mortality and morbidity were still unclear. For TECAB, Bonatti and colleagues [20] analyzed the 5-year results and reported survival rates of 95.8% and 93.9% for single-and double-vessel disease, respectively [20], while Jegaden and colleagues [21] reported a 96% survival and 88% freedom form re-intervention at 3 years after surgery, and a study [22] showed a graft patency of 92.7% at 8 years after TECAB. Fewer studies on MINICAB were reported.…”

A systematic review on robotic coronary artery bypass graft surgery

“…After exclusion of duplicated studies and 546 irrelevant articles based on abstracts and titles, 126 studies remained for full-text evaluation. Of these, 44 studies met the inclusion criteria, including nine studies in the TECAB off-pump group (10)(11)(12)(13)(14)(15)(16)(17)(18); two studies in the TECAB on-pump group (19,20); and 16 studies in the robotic MIDCAB group (10,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). One study provided separate data for both the TECAB offpump and robotic MIDCAB groups, and was included for analysis in both groups (10).…”

Long-term results after robotically assisted coronary bypass surgery

“…Only one study, however, described this endpoint at 5-years and included complex hybrid interventions in patients with multi-vessel disease (7). Freedom from angina rates in the studies that reported on earlier time points ranged from 85% to 100% (1,2,6,11). Out of the larger CABG studies, the ARTS trial demonstrated a 5-year angina recurrence rate of 15.5% for CABG, and 21.2% for percutaneous coronary intervention (PCI) using bare metal stents (14).…”