Document Detail


Effectiveness and safety of total endoscopic left internal mammary artery bypass graft to the left anterior descending artery.
MedLine Citation:
PMID:  19962475     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Johannes Bonatti; Thomas Schachner; Nikolaos Bonaros; Armin Oehlinger; Dominik Wiedemann; Elisabeth Ruetzler; Felix Weidinger; Christian Kolbitsch; Gudrun Feuchtner; David Zimrin; Guy Friedrich; Otmar Pachinger; Guenther Laufer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  104     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-07     Completed Date:  2010-02-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1684-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Maryland, Baltimore, MD, USA. jbonatti@smail.umaryland.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Coronary Artery Disease / surgery*
Coronary Vessels / surgery
Endoscopy
Female
Humans
Internal Mammary-Coronary Artery Anastomosis / methods*
Male
Mammary Arteries / transplantation*
Middle Aged
Perioperative Care*
Robotics*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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