Results of the Prospective Multicenter Trial of Robotically Assisted Totally Endoscopic Coronary Artery Bypass Grafting

Argenziano, Michael; Katz, Marc; Bonatti, Johannes; Srivastava, Sudhir; Murphy, Douglas A.; Poirier, Robert A.; Loulmet, Didier F.; Siwek, Leland; Kreaden, Usha; Ligon, David

doi:10.1016/j.athoracsur.2005.11.007

Cited by 184 publications

(101 citation statements)

References 19 publications

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“…Similarly, although Srivastava, Poston and Subramanian reported mean total operative times of 311, 348 and 444 minutes, respectively, they also averaged 1.9-2.2 grafts, accounting for the increased operative time spent on conduit harvesting and performing the additional anastomoses (29,30,32). In addition, studies of on-pump TECAB, such as the multiinstitutional study by Argenziano and colleagues, reported longer operative times due to the need for peripheral cannulation and use of a cardiopulmonary circuit (20). Finally, perioperative outcomes such as ventilation time, ICU stay, and total hospitalization time were dependent on clinical pathways specific to each institution, and prolonged times may have been multi-factorial (10).…”

Section: Discussionmentioning

confidence: 99%

“…This was not an unexpected finding, as the use of cardiopulmonary bypass was acknowledged as a 'stepping stone' to off-pump TECAB for surgeons who were overcoming their technical learning curves (20). Although cardiopulmonary bypass and cardioplegia allowed the surgeon to operate on an arrested heart, the addition of peripheral cannulation and aortic clamping prolonged the operative duration, and added complications such as groin wound infections and vascular injuries (20).…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

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A systematic review on robotic coronary artery bypass graft surgery

Cao

Indraratna

Doyle

et al. 2016

Ann. Cardiothorac. Surg.

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Background: Robotic-assisted coronary artery bypass graft surgery (CABG) has been performed over the past decade. Despite encouraging results from selected centres, there is a paucity of robust clinical data to establish its clinical safety and efficacy. The present systematic review aimed to identify all relevant clinical data on robotic CABG. The primary endpoint was perioperative mortality, and secondary endpoints included perioperative morbidities, anastomotic complications, and long-term survival.Methods: Electronic searches were performed using three online databases from their dates of inception to 2016. Relevant studies fulfilling the predefined search criteria were categorized according to surgical techniques as (I) totally endoscopic coronary artery bypass without cardiopulmonary bypass (TECAB offpump); (II) TECAB on-pump; and robotic-assisted mammary artery harvesting followed by minimally invasive direct coronary artery bypass (robotic MIDCAB).Results: The present systematic review identified 44 studies that fulfilled the study selection criteria, including nine studies in the TECAB off-pump group and 16 studies in the robotic MIDCAB group.Statistical analysis reported a pooled mortality of 1.7% for the TECAB off-pump group and 1.0% for the robotic MIDCAB group. Intraoperative details such as the number and location of grafts performed, operative times and conversion rates, as well as postoperative secondary endpoints such as morbidities, anastomotic complications and long-term outcomes were also summarized for both techniques.Conclusions: A number of technical, logistic and cost-related issues continue to hinder the popularization of the robotic CABG procedure. Current clinical evidence is limited by a lack of randomized controlled trials, heterogeneous definition of techniques and complications, as well as a lack of robust clinical followup with routine angiography. Nonetheless, the present systematic review reported acceptable perioperative mortality rates for selected patients at specialized centres. These results should be considered as a useful benchmark for future studies, until further data is reported in the form of randomized trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review on robotic coronary artery bypass graft surgery

Cao

Indraratna

Doyle

et al. 2016

Ann. Cardiothorac. Surg.

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“…In a prospective, multicenter study that was the first to evaluate the efficacy and safety of TECAB and ultimately led to FDA approval of this procedure, Argenziano and colleagues found 91% freedom from graft failure at 3 months and a 5.9% rate of major adverse cardiac events, which is less than reported in patients undergoing single-vessel CABG via median sternotomy in the Society for Thoracic Surgery database. 32 As described by Loulmet et al, TECAB is performed using a robotic surgical system with three arms inserted into the thoracic cavity. 30 After single lung ventilation and carbon dioxide chest insufflation are established, the first arm is inserted through the fourth intercostal space at the midclavicular line so it faces the anastomotic site and allows visualization of the entire length of the LIMA.…”

Section: Totally Endoscopic Cabgmentioning

confidence: 99%

Minimally Invasive Cardiovascular Surgery: Incisions and Approaches

Langer¹,

Argenziano

2016

Methodist DeBakey Cardiovascular Journal

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Throughout the modern era of cardiac surgery, most operations have been performed via median sternotomy with cardiopulmonary bypass. This paradigm is changing, however, as cardiovascular surgery is increasingly adopting minimally invasive techniques. Advances in patient evaluation, instrumentation, and operative technique have allowed surgeons to perform a wide variety of complex operations through smaller incisions and, in some cases, without cardiopulmonary bypass. With patients desiring less invasive operations and the literature supporting decreased blood loss, shorter hospital length of stay, improved postoperative pain, and better cosmesis, minimally invasive cardiac surgery should be widely practiced. Here, we review the incisions and approaches currently used in minimally invasive cardiovascular surgery.

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“…80 Totally endoscopic coronary artery bypass, which is facilitated by offpump and robotic techniques with anastomotic facilitating devices, has also been well described. 81 Hybrid coronary revascularization (HCR) is an alternative strategy that combines a minimally-invasive, sternal-sparing EndoACAB with PCI to LAD or non-LAD coronary lesions. Either staged or simultaneous, a best-matched strategy for a specific anatomic lesion is believed to be the advantage of the hybrid approach.…”

Section: Minimally-invasive and Hybrid Approachesmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Grafting

Polomsky

Puskas

2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he gold standard for multivessel coronary revascularization continues to be coronary artery bypass grafting (CABG). Despite advances in percutaneous coronary intervention (PCI) and medical therapy, CABG still plays a major role in the treatment of patients with coronary disease. Although an abundance of literature comparing on-pump (ONCAB) vs. off-pump (OPCAB) CABG exists, the optimal surgical strategy remains in question. The interest in off-pump techniques has largely been driven by the increased awareness of the deleterious effects of cardiopulmonary bypass (CPB) and aortic manipulation. Although many surgeons and centers have adopted this technique, OPCAB utilization appears to have reached a plateau in recent years and currently accounts for only approximately one-fifth of revascularizations performed, with the majority of CABG being performed on-pump worldwide.Advocates of the ONCAB approach cite low morbidity and mortality, with outcomes that have continued to improve despite a surgical patient population with increasing comorbid medical conditions and more severe coronary disease. However, complications such as renal failure and stroke continue to occur. These complications may occur not only because of the systemic inflammatory activation that occurs with extracorporeal circulation, but also because of the manipulation of the aorta required for cannulation, CPB, and aortic clamping. For most surgeons, the lack of compelling evidence in randomized controlled trials supporting OPCAB over ONCAB has been an impediment to implementing this strategy in routine practice.Furthermore, many surgeons consider an off-pump approach more technically challenging and demanding. Other points of controversy include mixed reports on graft patency, completeness of revascularization, and the need for repeat revascularization. Recent studies have suggested that certain high-risk patient subgroups are more likely to benefit from an OPCAB approach. These include patients with advanced ascending aortic atherosclerosis, ventricular dysfunction, renal insufficiency, diabetes, advanced age, and chronic lung disease, all of which tend to be increasingly common among patients referred for CABG. In these high-risk patients, avoiding the deleterious effects of CPB and minimizing or avoiding aortic manipulation may lead to improved short-term outcomes. Therefore, it is important for coronary surgeons to be facile with OPCAB techniques in order to implement this strategy when warranted. In-Hospital MortalitySince the refinement of OPCAB techniques, several randomized trials have reported significant advantages of OPCAB over ONCAB with respect to transfusion requirement, myocardial enzyme release, duration of mechanical ventilation, ICU and hospital lengths of stay, and cost-effectiveness. 1-14 However, those trials have not shown an in-hospital mortality advantage for OPCAB compared with ONCAB, perhaps because of the small sample sizes and ...

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Results of the Prospective Multicenter Trial of Robotically Assisted Totally Endoscopic Coronary Artery Bypass Grafting

Cited by 184 publications

References 19 publications

A systematic review on robotic coronary artery bypass graft surgery

A systematic review on robotic coronary artery bypass graft surgery

Minimally Invasive Cardiovascular Surgery: Incisions and Approaches

Off-Pump Coronary Artery Bypass Grafting

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