| Objective To investigate mid-long term graft patency, incidence of MACCE, survival rate of robotic coronary artery bypass on beating heart as well as respective influencing factors.Methods1. Subjects All cases that received robotic coronary artery bypass on beating heart at PLA General Hospital from January 2007 to December 2014 were included for retrospective study, among which 140 cases had minimally invasive direct coronary artery bypass(MIDCAB), while another 100 cases received totally endoscopic coronary bypass(TECAB). All of these procedures were completed on beating heart (i.e. off pump). Staged hybrid coronary revascularization was applied for subjects with indicated multi-vessel disease.2. Surgery TECAB:After routine induction of anesthesia, double-lumen intubation was carried out for single right lung ventilation.Camera and the instrument of the Da Vince system were docked through left chest wall. LIMA were harvest totally endoscopically with grafting completed in closed chest as well; MIDCAB:Manual anastomoses were performed on the beating heart through a small left anterior thoracotomy (6 cm) after a robotic LIMA takedown. Graft flow weremeasured by VeriQC system.3. Postoperative care All subjects received intensive care routinely and returned to general ward later. Staged hybrid coronary revascularization was applied for subjects with stent(s) implanted within 2 weeks. Graft flowed were rechecked with angiography for TECAB patient while Multi-Slice Computed Tomography for MIDCAB patient before discharge.4. Follow-up 92 out of 100(92.0%) TECAB patients were successfully followed up for 40.5±22.5 (3 to 95) months. Among 140 MIDCAB patients,128(91.4%) were followed up for 41.2±29.1 (1 to 97) months.Results1. Internal mammal artery was applied in all TECAB patients, with average graft flow 34.5±20.1ml/min. One case turned to MIDCAB due to insufficient exposure caused by severe calcification and excessive branch bleeding. One case had totally endoscopic reexploration for bleeding. Another one case who had patent graft verified by angiography 2 weeks after surgery died early due to asymptomatic myocardial infarction. Graft flow were 21.8±13.7ml/min among MIDCAB patients, among which 3 cases had dual IMAs applied. Neither intraoperative deaths nor lethal complication occurred in MIDCAB patients.2. A total of 33 case had staged hybrid coronary revascularization (17 of TECAB and 16 of MIDCAB)3. Postoperative graft patency of 6 months, one year, three years and 3+years were 100%,98.86%,98.86%,98.86% for TECAB and 100%,98.78%,97.54%,97.54% for MIDCAB, respectively.4.6 MACCE occurred in TECAB patients (5 deaths and 1 re-revascularization) while another 2 in MIDCAB (both were re-revascularization).5. Postoperative survival rate of 1year,3 years,5 years and 8years were 98.91%, 96.74%,94.54%,94.54%, respectively for TECAB and 100% successively for MIDCAB.Conclusions Robotic-assisted CABG is feasible and safe for selected cases with single or multi-vessel disease.the long-term survival rate was and graft patency are perfect. |
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