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Ann Thorac Surg 2006;81:1666-1675
© 2006 The Society of Thoracic Surgeons
a Milstein Hospital, Columbia University, New York, New York
b Henrico Doctors' Hospital, Richmond, Virginia
c Leopold-Franzen-Universitat Innsbruck, Klinische Abteilung fur Herzchirurgie, Innsbruck, Austria
d Alliance Hospital, Odessa, Texas
e St. Joseph Hospital of Atlanta, Atlanta, Georgia
f Saint Agnes Medical Center, Fresno, California
g Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, New York
h Sacred Heart Medical Center, Spokane, Washington
i Intuitive Surgical Inc, Sunnyvale, California
Accepted for publication November 3, 2005.
* Address correspondence to Dr Argenziano, New York Presbyterian Hospital, Columbia Presbyterian Medical Center, Department of Cardiothoracic Surgery, 177 Fort Washington Ave, Milstein Hospital, Suite 7-435, New York, NY 10032 (Email: ma66{at}columbia.edu).
Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.
BACKGROUND: Robotic technology has been proven safe and efficacious in the performance of mitral valve repair and atrial septal defect repair. This report describes a Food and Drug Administration-sanctioned multicenter study of the safety and efficacy of the da Vinci system (Intuitive Surgical, Inc, Mountain View, CA) for totally endoscopic coronary artery bypass (TECAB) surgery.
METHODS: Patients requiring left anterior descending (LAD) coronary artery revascularization were eligible. The procedure was performed with femoro-femoral cardiopulmonary bypass (CPB), endoaortic balloon occlusion, and thoracoscopy. All aspects of the procedure were performed with the robotic system, from internal mammary artery harvest to coronary anastomosis.
RESULTS: Ninety-eight patients requiring single-vessel LAD revascularization were enrolled at 12 centers. Thirteen patients (13%) were excluded intraoperatively (eg, failed femoral cannulation, inadequate working space). In 85 patients (69 men, age 58 ± 10 years) who underwent TECAB, CPB time was 117 ± 44 minutes, cross-clamp time was 71 ± 26 minutes, and hospital length of stay was 5.1 ± 3.4 days. There were five (6%) conversions to open techniques. There were no deaths or strokes, one early reintervention, and one myocardial infarction (1.5%). Three-month angiography was performed in 76 patients, revealing significant anastomotic stenoses (> 50%) or occlusions in 6 patients. Overall freedom from reintervention or angiographic failure was 91%.
CONCLUSIONS: Robotic TECAB was accomplished with no mortality, low morbidity, and angiographic patency and reintervention rates comparable with published data. Although the use of CPB was a limitation of the technique, this experience represents a step toward more advanced procedures, such as multivessel or off-pump TECAB.
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