Evaluation of Robotic Coronary Surgery With Intraoperative Graft Angiography and Postoperative Multislice Computed Tomography

Abstract

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. 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. 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. 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.