Influence of anastomotic techniques in totally endoscopic coronary artery bypass

Abstract

Beating heart totally endoscopic coronary artery bypass grafting (TECAB) utilizing a computer-enhanced telemanipulation system is a technically challenging procedure. The objective of our study was to compare two different anastomotic techniques. Ten canine beating heart TECAB procedures were performed using Intuitive's daVinci surgical system. Left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) anastomosis was performed on all subjects. Anastomosis varied between a conventional running suture (8-0 Gore-tex) (group I) and an interrupted nitinol u-clip anastomosis (group II). On-table angiography was then performed to assess graft patency. While internal mammary artery (IMA) mobilization time decreased over the course of the study (p = 0.017), there was no significant difference in ischaemia time, anastomosis time or angiographic assessment between anastomotic techniques. Although operative time in group II was significantly shorter than in group I, this was likely due to the small sample size. There were no differences in anastomotic time or coronary occlusion time. There were also no significant differences in canine weight, IMA mobilization time, lipectomy/pericardiotomy, LAD identification, subxiphoid port placement, stabilizer position, or LAD dissection time between the cases performed with the conventional running suture and the cases performed with u-clips. Interrupted nitinol clip anastomosis or conventional running suture anastomoses are equally favourable in the short term when performing a TECAB procedure.