106 Minimally invasive myocardial revascularization with robotic assistance

Abstract

BackgroundMinimally invasive myocardial revascularization (MIDCAB) with robotic assistance consists in IMA harvesting with DaVinci robotic system, followed by direct coronary anastomosis through minithoracotomy. We report the experience of this technique at Hôpital du Sacré-Cœur de Montréal.Method/resultsCharts were reviewed for perioperative and follow-up data. From August 2006 to April 2011, 31 patients underwent MIDCAB with robotic assistance. Median age was 60, 34.8% were female, and median Parsonnet score was 3. All patients had ostial or very proximal lésion on LAD, not amenable to percutaneous revascularization. The LIMA was harvested in all cases ; in two patients, RIMA was also harvested. There was three cases of hybrid revascularization, in which MIDCAB surgery was followed by PCI on either the right or the circumflex system. Conversion to standard offpump open technique happened in 3 cases. Reasons for conversion were ventricular arythmia secondary to hypothermia, bleeding at trocart insertion, and LIMA friability. None of these patients had any other operative complication. Median operative time was 188 minutes. There was no perioperative MI, CVA or mortality. Median post operative stay was 4 days. All patients, except one had clinical follow-up with exercise stress test ; médian follow-up time is 23 months. There was one repeat revascularization on LAD by PCI; the LIMA was found to be patent, but of small caliber. All patients demonstrated good functionnal class (median NYHA 1).ConclusionMinimally invasive myocardial revascularization (MIDCAB) with robotic assistance is safe and represent an alternative to PCI when the LAD lesion is not amenable to the latter. BackgroundMinimally invasive myocardial revascularization (MIDCAB) with robotic assistance consists in IMA harvesting with DaVinci robotic system, followed by direct coronary anastomosis through minithoracotomy. We report the experience of this technique at Hôpital du Sacré-Cœur de Montréal. Minimally invasive myocardial revascularization (MIDCAB) with robotic assistance consists in IMA harvesting with DaVinci robotic system, followed by direct coronary anastomosis through minithoracotomy. We report the experience of this technique at Hôpital du Sacré-Cœur de Montréal. Method/resultsCharts were reviewed for perioperative and follow-up data. From August 2006 to April 2011, 31 patients underwent MIDCAB with robotic assistance. Median age was 60, 34.8% were female, and median Parsonnet score was 3. All patients had ostial or very proximal lésion on LAD, not amenable to percutaneous revascularization. The LIMA was harvested in all cases ; in two patients, RIMA was also harvested. There was three cases of hybrid revascularization, in which MIDCAB surgery was followed by PCI on either the right or the circumflex system. Conversion to standard offpump open technique happened in 3 cases. Reasons for conversion were ventricular arythmia secondary to hypothermia, bleeding at trocart insertion, and LIMA friability. None of these patients had any other operative complication. Median operative time was 188 minutes. There was no perioperative MI, CVA or mortality. Median post operative stay was 4 days. All patients, except one had clinical follow-up with exercise stress test ; médian follow-up time is 23 months. There was one repeat revascularization on LAD by PCI; the LIMA was found to be patent, but of small caliber. All patients demonstrated good functionnal class (median NYHA 1). Charts were reviewed for perioperative and follow-up data. From August 2006 to April 2011, 31 patients underwent MIDCAB with robotic assistance. Median age was 60, 34.8% were female, and median Parsonnet score was 3. All patients had ostial or very proximal lésion on LAD, not amenable to percutaneous revascularization. The LIMA was harvested in all cases ; in two patients, RIMA was also harvested. There was three cases of hybrid revascularization, in which MIDCAB surgery was followed by PCI on either the right or the circumflex system. Conversion to standard offpump open technique happened in 3 cases. Reasons for conversion were ventricular arythmia secondary to hypothermia, bleeding at trocart insertion, and LIMA friability. None of these patients had any other operative complication. Median operative time was 188 minutes. There was no perioperative MI, CVA or mortality. Median post operative stay was 4 days. All patients, except one had clinical follow-up with exercise stress test ; médian follow-up time is 23 months. There was one repeat revascularization on LAD by PCI; the LIMA was found to be patent, but of small caliber. All patients demonstrated good functionnal class (median NYHA 1). ConclusionMinimally invasive myocardial revascularization (MIDCAB) with robotic assistance is safe and represent an alternative to PCI when the LAD lesion is not amenable to the latter. Minimally invasive myocardial revascularization (MIDCAB) with robotic assistance is safe and represent an alternative to PCI when the LAD lesion is not amenable to the latter.