Technique of closed chest coronary artery surgery on the beating heart

Objective: The application of an endoscopic stabilizer (Intuitive Surgical. Mountain View, CA. USA) enables closed chest off-pump coronary artery bypa ss via a four-point stab incision avoiding sternotomy and minithoracotomy. Methods: Between May 1999 and January 2001 we operated upon a total of 37 p atients (five female, 32 male, median age 62 +/- 9 years) suffering from co ronary artery disease using totally endoscopic coronary artery bypass (TECA B), whereas an initial series of eight TECAB patients was operated upon usi ng an endovascular bypass system (Heartport). The da Vinci surgical system was used in order to perform left internal mammary artery (LIMA) or right i nternal mammary artery (RIMA) harvesting and anastomoses on a beating heart in 29 patients (four female, 25 male, median age 64 +/- 9.8 years). Altoge ther 26 patients suffering from single-vessel coronary artery disease (SVCA D) were revascularized applying LIMA to the left anterior descending artery (LAD) and three patients with two diseased coronary vessels received bilat eral internal mammary artery grafting (BIMA), respectively. Results: In thi s series we had a 100% survival rate. Conversion rate to a median sternotom y was 3.4%. Patients were operated upon via four 1-cm chest incisions using the da Vinci robot for LIMA or BIMA harvesting and for performance of anas tomoses on the beating heart. In the overall series of 56 patients intended to be treated by TECAB. 19 (33.9%) were converted to a minimally invasive direct coronary artery bypass procedure. Conclusion: This new robotic-enhan ced surgical technique promotes an optimistic way of thinking about the fur ther development of this procedure and its application in patients sufferin g from single-vessel CAD. (C) 2001 Elsevier Science B.V. All rights reserve d.