Abstract
Background. Complete surgical revascularization that includes left internal thoracic artery grafting to the left anterior descending coronary artery remains the gold standard of treatment for coronary artery disease. Not all patients are good candidates for sternotomy. Therefore, we sought to identify a strategy that would combine the long-term advantages of internal thoracic artery grafting to lessen surgical trauma while still allowing complete revascularization. Methods. A total of 54 consecutive patients from four institutions underwent hybrid revascularization combining surgery and angioplasty. All internal thoracic artery grafts were endoscopically harvested with robotic assistance using either the Aesop or Zeus system, and all anastomoses were manually constructed through a 4- to 6-cm anterior thoracotomy incision. Angioplasty was carried out to achieve total revascularization to ungrafted vessels. Results. There were no early or late deaths, myocardial infarctions, strokes, or wound infections. Of the patients, 37 (69%) were extubated in the operating room. Length of stay in the intensive care unit averaged 24.4 hours and hospital stay 3.45 days. In all, 16 patients (29.6%) required transfusion of packed red blood cells. Late complications included I patient with stent occlusion at 3 months and 2 patients with in-stent restenosis. Three patients were treated for postpericardiotomy syndrome. Mean follow-up was 11.7 months. Event-free was survival 87.1% and freedom from recurrent angina 98.3%. Conclusions. Hybrid endoscopic atraumatic internal thoracic artery to anterior descending coronary artery graft surgery combined with angioplasty is a reasonable revascularization strategy in multiple vessel coronary artery disease in selected patients. Longer follow-up and more patient data in a randomized study are needed to determine the patient cohort most likely to benefit from this approach.
| Original language | English (US) |
|---|---|
| Journal | Annals of Thoracic Surgery |
| Volume | 74 |
| Issue number | 4 |
| State | Published - Oct 1 2002 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
Cite this
Hybrid robotic coronary artery surgery and angioplasty in multivessel coronary artery disease. / Stahl, Kenneth D.; Boyd, Walter D; Vassiliades, Thomas A.; Karamanoukian, Hratch L.
In: Annals of Thoracic Surgery, Vol. 74, No. 4, 01.10.2002.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Hybrid robotic coronary artery surgery and angioplasty in multivessel coronary artery disease
AU - Stahl, Kenneth D.
AU - Boyd, Walter D
AU - Vassiliades, Thomas A.
AU - Karamanoukian, Hratch L.
PY - 2002/10/1
Y1 - 2002/10/1
N2 - Background. Complete surgical revascularization that includes left internal thoracic artery grafting to the left anterior descending coronary artery remains the gold standard of treatment for coronary artery disease. Not all patients are good candidates for sternotomy. Therefore, we sought to identify a strategy that would combine the long-term advantages of internal thoracic artery grafting to lessen surgical trauma while still allowing complete revascularization. Methods. A total of 54 consecutive patients from four institutions underwent hybrid revascularization combining surgery and angioplasty. All internal thoracic artery grafts were endoscopically harvested with robotic assistance using either the Aesop or Zeus system, and all anastomoses were manually constructed through a 4- to 6-cm anterior thoracotomy incision. Angioplasty was carried out to achieve total revascularization to ungrafted vessels. Results. There were no early or late deaths, myocardial infarctions, strokes, or wound infections. Of the patients, 37 (69%) were extubated in the operating room. Length of stay in the intensive care unit averaged 24.4 hours and hospital stay 3.45 days. In all, 16 patients (29.6%) required transfusion of packed red blood cells. Late complications included I patient with stent occlusion at 3 months and 2 patients with in-stent restenosis. Three patients were treated for postpericardiotomy syndrome. Mean follow-up was 11.7 months. Event-free was survival 87.1% and freedom from recurrent angina 98.3%. Conclusions. Hybrid endoscopic atraumatic internal thoracic artery to anterior descending coronary artery graft surgery combined with angioplasty is a reasonable revascularization strategy in multiple vessel coronary artery disease in selected patients. Longer follow-up and more patient data in a randomized study are needed to determine the patient cohort most likely to benefit from this approach.
AB - Background. Complete surgical revascularization that includes left internal thoracic artery grafting to the left anterior descending coronary artery remains the gold standard of treatment for coronary artery disease. Not all patients are good candidates for sternotomy. Therefore, we sought to identify a strategy that would combine the long-term advantages of internal thoracic artery grafting to lessen surgical trauma while still allowing complete revascularization. Methods. A total of 54 consecutive patients from four institutions underwent hybrid revascularization combining surgery and angioplasty. All internal thoracic artery grafts were endoscopically harvested with robotic assistance using either the Aesop or Zeus system, and all anastomoses were manually constructed through a 4- to 6-cm anterior thoracotomy incision. Angioplasty was carried out to achieve total revascularization to ungrafted vessels. Results. There were no early or late deaths, myocardial infarctions, strokes, or wound infections. Of the patients, 37 (69%) were extubated in the operating room. Length of stay in the intensive care unit averaged 24.4 hours and hospital stay 3.45 days. In all, 16 patients (29.6%) required transfusion of packed red blood cells. Late complications included I patient with stent occlusion at 3 months and 2 patients with in-stent restenosis. Three patients were treated for postpericardiotomy syndrome. Mean follow-up was 11.7 months. Event-free was survival 87.1% and freedom from recurrent angina 98.3%. Conclusions. Hybrid endoscopic atraumatic internal thoracic artery to anterior descending coronary artery graft surgery combined with angioplasty is a reasonable revascularization strategy in multiple vessel coronary artery disease in selected patients. Longer follow-up and more patient data in a randomized study are needed to determine the patient cohort most likely to benefit from this approach.
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UR - http://www.scopus.com/inward/citedby.url?scp=0036798188&partnerID=8YFLogxK
M3 - Article
C2 - 12400817
AN - SCOPUS:0036798188
VL - 74
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 4
ER -