Prospective clinical trial of robotically assisted endoscopic coronary grafting with 1-year follow-up

Objective To follow up in prospective fashion patients with coronary artery anastomos es completed endoscopically with robotic assistance. The robotic system was evaluated for safely and its effectiveness in completing microsurgical cor onary anastomoses. Summary Background Data Recently there has been an interest in using robotics and computers to enha nce the surgeon's ability to perform endoscopic cardiac surgery. This inter est has stemmed from the rapid advancement of technology and the desire to make cardiac surgery less invasive. Using traditional endoscopic instrument s, it has not been possible to perform coronary surgery. Methods Nineteen patients underwent robotically assisted endoscopic coronary artery bypass grafting of the left internal thoracic artery (LITA) to the left an terior descending artery (LAD). Two robotic instruments and one endoscopic camera were placed through three 5-mm ports. A robotic system was used to c onstruct the LITA-LAD anastomosis. All other required grafts were completed by conventional techniques. Results Seventeen LITA-LAD grafts (89%) had adequate intraoperative flow. T he mean LITA-LAD graft flow was 38.5 +/- 5 mL/min. At 8 weeks, LITA-LAD gra fts were assessed by angiography and showed 100% patency with thrombolysis in myocardial infarction (TIMI) I flow. At a mean follow-up of 17 +/- 4.2 m onths, all patients were NYHA class I and there were no adverse cardiac eve nts. Conclusions The results from the first prospective clinical trial of robotically assist ed endoscopic coronary bypass surgery in the United Stales showed favorable short-term outcomes with no adverse events. Robotic assistance is an enabl ing technology allowing the performance of endoscopic coronary anastomoses.