Robotic Totally Endoscopic Triple Coronary Artery Bypass Grafting on the Arrested Heart: Report of the First Successful Clinical Case

Abstract

Robotic technology enables "port only" totally endoscopic coronary artery bypass grafting (TECAB). During early procedure development only single bypass grafts were feasible. Because current referral practice for coronary bypass surgery mostly includes multivessel disease, performance of multiple endoscopic bypass grafts is desirable. We report a case in which a patient received a right internal mammary artery bypass graft to the left anterior descending artery and a left internal mammary artery jump graft to 2 obtuse marginal branches. The procedure was performed through 5 ports on the arrested heart using the daVinci S robotic surgical system. This is the first reported triple bypass grafting procedure using an arrested heart approach.

Cirurgia cardíaca videoassistida

“…Several authors have used this technique including Brazil [28,52], but the greatest advances in minimally invasive CABG have been shown today. Surgical procedures using robotics have allowed for multivessel coronary revascularization, in a totally endoscopic manner [53,54].…”

“…The future is even more promising because, as already happens in some centers, the smaller incisions will be replaced by totally endoscopic procedures [53,54].…”

Robotic totally endoscopic surgery for congenital cardiac anomalies

“…On the one hand there are pioneers pushing the technology and its application forward [26,27] and on the other hand critics are trying to ban the technique from the field [28]. While these critics already hit the adult field one can imagine that it will be even harder to introduce robotic surgery into congenital heart disease where patients are much younger and no learning curves are tolerated.…”

Robotically Assisted Totally Endoscopic Coronary Bypass Surgery

“…Our team at the University of Maryland has performed the first triple-vessel AHTECAB worldwide. 22 Sequential bypass grafts 7 and Y grafts can be constructed in completely endoscopic fashion. Another major advantage of AHTECAB compared with TECAB on the beating heart (BHTECAB) is that the completely flaccid arrested heart can be rotated easily for access to the circumflex coronary artery system without concern for hemodynamic insufficiency.…”