Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Abstract

During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra-and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.

Robotic Cardiac Surgery in Europe: Status 2020

“…(B) Growth in the number of robotic procedures during 2016–2019. (C) Growth in the number of robotic procedures during 1998–2019, including data by Pettinari et al ( 10 ). (D) Growth of active robotic cardiac centers in Europe during 2016–2019.…”

“…A recent 25-year review reported on 1,762 RA-MIDCAB and 1,678 robotic TECAB procedures ( 10 ). RA-MIDCAB resulted in 6.6% conversion to larger incisions, 1.9% revision for bleeding, 0.4% stroke, and 0.4% mortality.…”

Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization

“…A recent review done by Bonatti J et al [20], reviewing a total of 74 patient series published between 1996 and 2019, shows that 27.8% of the reported robotic-assisted procedures represent multivessel CABGs. In this review, the operative times reached 5.3 ± 0.8 hours, the cumulative conversion rate was 10.3%, the perioperative mortality reached 1.3%, the mean length of hospital stay was 5.2 ± 1.6 days, and the 3-year survival was reported in 2 papers as 96% and 95.5%.…”

“…In this review, the operative times reached 5.3 ± 0.8 hours, the cumulative conversion rate was 10.3%, the perioperative mortality reached 1.3%, the mean length of hospital stay was 5.2 ± 1.6 days, and the 3-year survival was reported in 2 papers as 96% and 95.5%. [20,21] This approach has shown adequate short-term clinical results and represents the minimally invasive technique with the least tissue trauma; however, there are no studies available reporting the procedure's long-term results, procedure times are usually longer than the other presented techniques, the learning curve has shown to require a triple-digit number of repetitions for the surgeon and team to achieve a comfort level demanding long training sessions, and it is a procedure dependent on complex technology with limited access and high costs for the moment [20,21]…”

Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis

“…The entire procedure is performed on a beating heart and without the use of cardiopulmonary bypass. The detailed technique of RA-MIDCAB has been described elsewhere (8). Three ports were used to facilitate the robotic procedure while permitting the chest to be insufflated with CO 2 , including one camera port into the 4th intercostal space on the left anterior axillary line and two instrument ports in the 2nd and 6th intercostal spaces close to the left midclavicular line.…”