| Effectiveness and safety of total endoscopic left internal mammary artery bypass graft to the left anterior descending artery. | |
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MedLine Citation:
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PMID: 19962475 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of cardiology Volume: 104 ISSN: 1879-1913 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-12-07 Completed Date: 2010-02-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1684-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, University of Maryland, Baltimore, MD, USA. jbonatti@smail.umaryland.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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