Effectiveness and Safety of Total Endoscopic Left Internal Mammary Artery Bypass Graft to the Left Anterior Descending Artery

Bonatti, Johannes; Schachner, Thomas; Bonaros, Nikolaos; Oehlinger, Armin; Wiedemann, Dominik; Ruetzler, Elisabeth; Weidinger, Felix; Kolbitsch, Christian; Feuchtner, Gudrun; Zimrin, David; Friedrich, Guy; Pachinger, Otmar; Laufer, Guenther

doi:10.1016/j.amjcard.2009.07.051

« Previous Next »American Journal of Cardiology
Volume 104, Issue 12 , Pages 1684-1688, 15 December 2009

Effectiveness and Safety of Total Endoscopic Left Internal Mammary Artery Bypass Graft to the Left Anterior Descending Artery

Johannes Bonatti, MD
- Department of Surgery, University of Maryland, Baltimore, Maryland
- Corresponding author: Tel: 410-328-9169; fax: 410-328-2750
Thomas Schachner, MD
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
Nikolaos Bonaros, MD, PhD
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
Armin Oehlinger, MD
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
Dominik Wiedemann, MD
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
Elisabeth Ruetzler, MD
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
Felix Weidinger, MD
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
Christian Kolbitsch, MD
- Department of Anesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria
Gudrun Feuchtner, MD
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
David Zimrin, MD
- Department of Cardiology, University of Maryland, Baltimore, Maryland
Guy Friedrich, MD
- Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
Otmar Pachinger, MD
- Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
Guenther Laufer, MD
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria

Received 2 June 2009; received in revised form 14 July 2009; accepted 14 July 2009.

Totally endoscopic coronary artery bypass grafting (CABG) has become a feasible option using robotic technology and remote access perfusion techniques. The aim of this study was to determine the progression of the procedure's performance in the currently largest single-center series of arrested-heart totally endoscopic CABG. From 2001 to 2007, arrested-heart totally endoscopic CABG was performed in 100 patients (median age 59 years, range 46 to 70; 81 men, 19 women). All patients received left internal mammary artery grafts to the left anterior descending artery using the da Vinci Surgical System. Remote-access femoral perfusion and aortic balloon endo-occlusion were used in all patients. The series was divided into 4 phases: phase 1 (patients 1 to 25), phase 2 (patients 26 to 50), phase 3 (patients 51 to 75), and phase 4 (patients 76 to 100). The conversion rates to larger thoracic incisions were 7 of 25 (28%) in phase 1, 2 of 25 (8%) in phase 2, 1 of 25 (4%) in phase 3, and 1 of 25 (4%) in phase 4 (p = 0.018). Operative times and hospital stays decreased significantly with each subsequent phase, and clinical outcome showed corresponding improvements. There was no perioperative mortality. For the whole patient series, 5-year postoperative survival, freedom from angina, and freedom from major adverse cardiac and cerebral events were 100%, 91%, and 89%, respectively. In conclusion, after an initial steep learning curve, completely endoscopic left internal mammary artery–to–left anterior descending CABG can be performed safely, with low conversion rates. The learning curve for operative times and improvements in clinical outcome continued even at 100 procedures.