Document Detail


Evaluation of robotic coronary surgery with intraoperative graft angiography and postoperative multislice computed tomography.
MedLine Citation:
PMID:  17383340     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Robotically assisted totally endoscopic coronary artery bypass graft surgery (TECABG) is an innovative minimally invasive procedure requiring proof of immediate- and short-term patency of grafts to compete with conventional bypass surgery or percutaneous coronary interventions. The purpose of this study was to evaluate the combination of invasive and noninvasive coronary angiography methods in innovative cardiac surgery as an approach to optimal quality control. METHODS: In 86 patients after robotic coronary surgery (62 arrested-heart TECABG, 20 through sternotomy with robotically assisted anastomoses, 4 beating-heart TECABG), intraoperative coronary angiography was performed with a mobile C-arm. All patients underwent multislice computed tomography angiography, and invasive coronary angiography was performed in 48 patients within 3 months after surgery. RESULTS: Bypass grafts could be visualized by intraoperative angiography in 84 patients (98%). Spasm of target vessels or bypass grafts, or both (reversible after intraluminal nitroglycerine application), was observed in 47%. In 9 patients, surgical revisions were performed owing to inadequate revascularization results. No angiography-related complications occurred. The sensitivity and specificity of multislice computed tomography for the evaluation of graft patency were 100% and 97%, respectively. The visualization of distal anastomoses and distal target vessels was good in 90% but limited in 10% because of artifacts, limited spatial resolution, and high image noise. CONCLUSIONS: The combination of intraoperative angiography and postoperative multislice computed tomography allows safe and high-quality evaluation of immediate- and short-term outcome in innovative robotic coronary surgery. Immediate revisions of bypass grafts are possible, to ensure that all patients leave the operating room with patent bypass grafts.
Authors:
Thomas Schachner; Gudrun M Feuchtner; Johannes Bonatti; Nikolaos Bonaros; Armin Oehlinger; Eva Gassner; Otmar Pachinger; Guy Friedrich
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-04-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1361-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. thomas.schachner@uibk.ac.at
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Coronary Angiography*
Coronary Artery Bypass / instrumentation*,  methods
Coronary Disease / radiography*,  surgery*
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
Male
Middle Aged
Monitoring, Intraoperative / methods
Postoperative Care / methods
Retrospective Studies
Risk Assessment
Robotics*
Severity of Illness Index
Surgical Procedures, Minimally Invasive / instrumentation,  methods
Tomography, Spiral Computed*
Treatment Outcome

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


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