The midterm outcome and MACE of robotically enhanced grafting of left anterior descending artery with left internal mammary artery

Abstract

Background: We assessed the midterm outcome and the incidence of major adverse cardiovascular events in UK's largest Da Vinci assisted robotic coronary revascularisation cohort. This study was set up at the Imperial College NHS Trust, St. Mary's Hospital, London, United Kingdom.

Method: Benchmarking approach through retrospective audit of the regional outcomes against standards in the published literature. Data was collected from the patient's records, communication with the primary care physicians and the national strategic tracing service. The results were compared with the published literature. Patients who underwent robotic assisted coronary revascularisation were included. Other robotic procedures or minimally invasive revascularisation without the use of the Da Vinci robot were excluded. The main outcome measure was the midterm survival up to five years and the incidence of major adverse cardiovascular events (MACE) up to three years.

Results: Since April 2002, one hundred consecutive patients underwent either off pump robotic assisted single vessel small thoracotomy (SVST, n=88), or off pump total endoscopic coronary artery bypass grafting (TCAB, n=12). All patients were operated on by the same primary surgeon but different assisting surgeons. All patients received a left internal mammary arterial (LIMA) graft as planned. The primary outcome of total one month and three years MACE and up to five year survival was 0, 9 and 96% respectively.

Conclusions: The procedural success rates in terms of morbidity and mortality up to five years are compatible to the outcomes observed outside the United Kingdom. These results are not inferior to that of conventional off pump single vessel coronary surgery or percutaneous coronary intervention to the LAD.

Figure 1

The standard second generation Da Vinci robot with three robotic arms. The middle arm commonly used for the camera.

Figure 2

SVST/TECAB surgical sequence. a) The port access position in the third, fifth and seventh interspaces. b) The operating surgeon controls the robotic arms from the console. c) The Left internal mammary artery is harvested using the Da Vinci robot. d) Pericardotomy is performed to expose the targeted left anterior descending artery. Then the coronary anastomosis is performed either e) through a small left thoracotomy (SVST) or f) totally endoscopically (TECAB).