Robotic total endoscopic double-vessel coronary artery bypass grafting-state of procedure development

被引:18
|
作者
Bonatti, Johannes [1 ]
Lehr, Eric J.
Schachner, Thomas [2 ]
Wiedemann, Dominik [2 ]
Weidinger, Felix [2 ]
Wehman, Brody
de Biasi, Andreas R.
Bonaros, Nikolaos [2 ]
Griffith, Bartley
机构
[1] Univ Maryland, Sch Med, Dept Surg, Div Cardiac Surg, Baltimore, MD 21201 USA
[2] Innsbruck Med Univ, Innsbruck, Austria
关键词
BEATING-HEART; SURGERY; DISEASE; EXPERIENCE;
D O I
10.1016/j.jtcvs.2012.08.023
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Robotic total endoscopic coronary artery bypass grafting (TECAB) has been under development for 10 years. With increasing experience and technological improvement, double-vessel TECAB has become feasible. The aim of the present study was to compare the current outcomes of single-and double-vessel TECAB. Methods: Between 2001 and 2011, 484 patients underwent TECAB by 4 surgeons at 2 institutions. The median patient age was 60 years (range, 31-90), and the median European System for Cardiac Operative Risk Evaluation was 2 (range, 0-13). Single-vessel (n = 334) and double-vessel (n 150) procedures were performed using the da Vinci, da Vinci S, and da Vinci Si robotic systems. Results: Compared with the single-vessel procedure, double-vessel TECAB required a longer operative time (median, 375 minutes; range, 168-795; vs median, 240; range, 112-605; P < .001) and had an increased conversion rate to a larger thoracic incision (31/150 [20.7%] vs 31/334 [9.3%]; P < .001). The median ventilation time was 10 hours (range, 0-288) for double-vessel versus 8 hours (range, 0-278) for single-vessel procedures (P = .006). The hospital stay was comparable, with 6 days (range, 2-27) for double-vessel TECAB and 6 days (range, 2-33) for single-vessel TECAB (P = .794). Perioperative mortality was 0.3% (1/334) with single-vessel TECAB and 2.0% (3/150) with double-vessel TECAB (P = .090). Freedom from major adverse cardiac and cerebral events at 5 years was similar after double-and single-vessel TECAB (73.5% vs 83.1%, P = .150). The 5-year survival was 95.8% and 93.9% (P = .708). Conclusions: Double-vessel TECAB appears feasible and reproducible. The operative times were longer and the conversion rates to a larger thoracic incision were greater than with single-vessel TECAB. Also, the postoperative ventilation time was longer. Other perioperative morbidity and mortality and the recovery time and long-term clinical outcomes, however, were comparable. (J Thorac Cardiovasc Surg 2012;144:1061-6)
引用
收藏
页码:1061 / 1066
页数:6
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