Comparison Of Short And Mid Term Results Of Different Minimally Invasive Off-pump Coronary Artery Bypass Grafting

ObjectiveTo compare the short and mid-term results of three off-pump coronary arterybypass grafting procedures, including totally endoscopic coronary artery bypass(TECAB), robotic assisted minimally invasive directed coronary artery bypassand traditional off-pump coronary artery bypass grafting (OPCAB). To comparethe graft patency in different anastomose and harvest technique.Methods1. Materials: between January2007and October2011,70patientsunderwent successful for beating heart TECAB,110for MIDCAB.125matched post OPCAB patients were chosen according to the clinicalcharacteristics of the MIDCAB patients.2. Operative techque:A. TECAB Skeletonized internal mammary artery was harvested viathe Da Vinci S/Si surgical system. An endoscopic stabilizer wasinserted and positioned over the target vessel. Then the surgeoncontrolled the arms to finish the anastomosing.B. MIDCAB Skeletonized internal mammary artery was harvested viathe Da Vinci S/Si surgical system. Then the robot system wasremoved. Acess to the chest was achieved through a4-6incision inthe left forth ICS. With the help of the Octopus stabilizer system, theanastomosis was performed on beating heart with hand sewn.C. OPCAB Pedicled internal mammary artery was harvested by handvia median sternotomy. With the help of the Octopus stabilizer system,the anastomosis was performed on beating heart with hand sewn. D. The graft blood flow was measured by the TTFM.3. Database collection: perioperative databases include operation time,anastomosing time, graft blood flow, blood lose, postoperative ventilationtime, ICU stay, postoperative hospital stay, postoperative complications.4. Follow up: To collect the major adverse cardiac event (MACE) and leftinternal mammary artery (LIMA) to anterior descending artery(LAD)graft patency in the short and mid-term by telephone and recheck afteroperation.Results1. All the patients were alive after operation. The mortality in TECAB was0, and3.6%in MIDCAB.2. All the internal mammary arteries were harvested successfully. The meanblood flow was higher in TECAB (33.45±21.25ml/min) than inMIDCAB (21.24±13.64ml/min).3. The MACE in the short and mid-term was0%in TECAB and1.8%inMIDCAB. The LIMA-LAD graft patency at6months-1year,1-3yearsin TECAB was96.9%，96.4%，and was100%at any time in MIDCAB.4. The mean blood flow was (21.24±13.64ml/min) in MIDCAB, and(19.56±9.38ml/min) in OPCAB. The LIMA-LAD graft patency at6months-1year,1-3years in MIDCAB was always100%，and was100%，95.8%in OPCAB.Conclusion1. There was no difference of complications, morbidity, graft patency in theshort and mid-term between TECAB and MIDCAB.2. The graft flow and patency in the short and mid-term were similar inMIDCAB and OPCAB.