Endoscopic computer-enhanced beating heart coronary artery bypass grafting

Background. Telemanipulation systems have enabled coronary revascularizatio n on the arrested heart. The purpose of this study was to develop a techniq ue for computer-enhanced endoscopic coronary artery bypass grafting on the beating heart. Methods. The operation was performed using the daVinci telemanipulation sys tem. Through three ports, the left internal thoracic artery was harvested i n 10 mongrel dogs (30 to 35 kg) using single right-lung ventilation and CO2 insufflation. Through a fourth port an articulating stabilizer, manipulate d from a second surgical console, was inserted to stabilize the heart. The left anterior descending artery was snared using silicone elastomer slings anchored in the stabilizer cleats and the graft to coronary artery anastomo sis was performed. Results. In 7 of 10 dogs, total endoscopic beating heart bypass grafting, c ardiac stabilization, arteriotomy, and arterial anastonosis were performed using computer-enhanced technology. Endoscopic stabilization and temporary left anterior descending artery occlusion were well tolerated. All grafts w ere patent although minor strictures were found in 2. In 3 dogs, the proced ure could not be completed (1 ventricular arrhythmia, 1 left atrial lacerat ion, and 1 right ventricular outflow tract compression). Conclusions. Endoscopic beating heart coronary artery bypass grafting is po ssible in a canine model using a computer-enhanced instrumentation system a nd articulating stabilization. (Ann Thorac Surg 2000;70:2029-33) (C) 2000 b y The Society of Thoracic Surgeons.