Minimally Invasive Coronary Bypass Grafting
Da Vinci robotic mammary harvest (LIMA) and off-pump grafting to the LAD with vessel imaging with US and flow measurements finally combine the advantage of LIMA-LAD grafting with a minimally invasive approach and open up the possibilities of hybrid revascularisation.
Having spent the last decade pursuing the “holy grail” of all arterial an-aortic off-pump coronary bypass grafting it is gratifying to see these ideals reflected in the recent European guidelines for revascularisation (see table below). Our Network meta-analysis of the influence of aortic manipulation on stroke has been used to generate a Class 1 Level of evidence B indication for an-aortic surgery. Our results for over 250 CAGS using these surgical principals are similarly impressive. There were no deaths and only one CVA (0.4%). Similarly the following benchmarks were world class: 99% all arterial revascularisation, 88% off-pump grafting, 97% LIMA usage, 73% RIMA usage and 64% had a Radial artery used. Only 1% of patients had a saphenous vein graft.
View the full review here.
I have personally extended these principals into minimally invasive surgery with over 60 cases of Da Vinci robotic mammary harvest and minithoracotomy LIMA to LAD anastomosis with “Medistim” confirmation of good anastomotic flow. There have been no emergency conversions for haemodynamic instability. The potential to perform multivessel arterial revascularisation without sternotomy with the use of hybrid strategies is finally being realised.
View a robotic assisted midcab HERE.
Pre: PCI distal Cx-PL
Post: PCI distal Cx-PL