Robot-assisted bilateral internal mammary arteries harvesting for off-pump coronary artery bypass grafting with 5 grafts by minimally invasive small incision: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Bing , CHENG Nan , SHEN Hua ,  WANG Rong

Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, 100853, Beijing, P.R.China;

Corresponding author：

WANG Rong, Email: wangrongd@126.com

Keywords：

Robot-assisted surgery; bilateral internal mammary arteries harvesting; minimally invasive incision; coronary artery bypass graftting with 5 grafts; case report

DOI：

10.7507/1007-4848.202103015

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy.Methods BIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch.Results The operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation.Conclusion Robot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.

Citation： LIU Bing, CHENG Nan, SHEN Hua, WANG Rong. Robot-assisted bilateral internal mammary arteries harvesting for off-pump coronary artery bypass grafting with 5 grafts by minimally invasive small incision: A case report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(6): 650-655. doi: 10.7507/1007-4848.202103015 Copy

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2.	Mulukutla SR, Gleason TG, Sharbaugh M, et al. Coronary bypass versus percutaneous revascularization in multivessel coronary artery disease. Ann Thorac Surg, 2019, 108(2): 474-480.
3.	Stone GW, Kappetein AP, Sabik JF, et al. Five-year outcomes after PCI or CABG for left main coronary disease. N Engl J Med, 2019, 381(19): 1820-1830.
4.	Sousa-Uva M, Neumann FJ, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur J Cardiothorac Surg, 2019, 55(1): 4-90.
5.	Nielsen SN, Rasmussen TB, Lassen JF, et al. The association between self-reported health status and adverse events: A comparison among coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). Qual Life Res, 2020, 29(11): 3017-3029.
6.	Rajput NK, Kalangi TKV, Andappan A, et al. MICS CABG: A single-center experience of the first 100 cases. Indian J Thorac Cardiovasc Surg, 2021, 37(1): 16-26.
7.	Ravikumar N, George V, Shirke MM, et al. Robotic coronary artery surgery: Outcomes and pitfalls. J Card Surg, 2020, 35(11): 3108-3115.
8.	Leyvi G, Vivek K, Sehgal S, et al. A comparison of inflammatory responses between robotically enhanced coronary artery bypass grafting and conventional coronary artery bypass grafting: Implications for hybrid revascularization. J Cardiothorac Vasc Anesth, 2018, 32(1): 251-258.
9.	Gong W, Cai J, Wang Z, et al. Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting. J Thorac Dis, 2016, 8(3): 459-468.
10.	Bonatti J, Wallner S, Crailsheim I, et al. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis, 2021, 13(3): 1922-1944.
11.	Chan V, Lapierre H, Sohmer B, et al. Handsewn proximal anastomoses onto the ascending aorta through a small left thoracotomy during minimally invasive multivessel coronary artery bypass grafting: A stepwise approach to safety and reproducibility. Semin Thorac Cardiovasc Surg, 2012, 24(1): 79-83.
12.	Han Z, Zhang G, Chen S, et al. Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting. J Cardiothorac Surg, 2021, 16(1): 2.
13.	成楠, 杨明, 王明岩, 等. 机器人辅助获取双侧乳内动脉行微创冠状动脉旁路移植术治疗冠心病多支血管病变. 机器人外科学杂志, 2020, 1(1): 43-49.
14.	Lin TH, Wang CW, Shen CH, et al. Clinical outcomes of multivessel coronary artery disease patients revascularized by robot-assisted vs conventional standard coronary artery bypass graft surgeries in real-world practice. Medicine (Baltimore), 2021, 100(3): e23830.
15.	Bhatt HV, Schuessler ME, Torregrossa G, et al. Robotic cardiac surgery part Ⅱ: Anesthetic considerations for robotic coronary artery bypass grafting. J Cardiothorac Vasc Anesth, 2020, 34(9): 2484-2491.

1. Manuel L, Fong LS, Wolfenden H, et al. Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?'. Ann Med Surg (Lond), 2020, 57: 264-267.
2. Mulukutla SR, Gleason TG, Sharbaugh M, et al. Coronary bypass versus percutaneous revascularization in multivessel coronary artery disease. Ann Thorac Surg, 2019, 108(2): 474-480.
3. Stone GW, Kappetein AP, Sabik JF, et al. Five-year outcomes after PCI or CABG for left main coronary disease. N Engl J Med, 2019, 381(19): 1820-1830.
4. Sousa-Uva M, Neumann FJ, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur J Cardiothorac Surg, 2019, 55(1): 4-90.
5. Nielsen SN, Rasmussen TB, Lassen JF, et al. The association between self-reported health status and adverse events: A comparison among coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). Qual Life Res, 2020, 29(11): 3017-3029.
6. Rajput NK, Kalangi TKV, Andappan A, et al. MICS CABG: A single-center experience of the first 100 cases. Indian J Thorac Cardiovasc Surg, 2021, 37(1): 16-26.
7. Ravikumar N, George V, Shirke MM, et al. Robotic coronary artery surgery: Outcomes and pitfalls. J Card Surg, 2020, 35(11): 3108-3115.
8. Leyvi G, Vivek K, Sehgal S, et al. A comparison of inflammatory responses between robotically enhanced coronary artery bypass grafting and conventional coronary artery bypass grafting: Implications for hybrid revascularization. J Cardiothorac Vasc Anesth, 2018, 32(1): 251-258.
9. Gong W, Cai J, Wang Z, et al. Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting. J Thorac Dis, 2016, 8(3): 459-468.
10. Bonatti J, Wallner S, Crailsheim I, et al. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis, 2021, 13(3): 1922-1944.
11. Chan V, Lapierre H, Sohmer B, et al. Handsewn proximal anastomoses onto the ascending aorta through a small left thoracotomy during minimally invasive multivessel coronary artery bypass grafting: A stepwise approach to safety and reproducibility. Semin Thorac Cardiovasc Surg, 2012, 24(1): 79-83.
12. Han Z, Zhang G, Chen S, et al. Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting. J Cardiothorac Surg, 2021, 16(1): 2.
13. 成楠, 杨明, 王明岩, 等. 机器人辅助获取双侧乳内动脉行微创冠状动脉旁路移植术治疗冠心病多支血管病变. 机器人外科学杂志, 2020, 1(1): 43-49.
14. Lin TH, Wang CW, Shen CH, et al. Clinical outcomes of multivessel coronary artery disease patients revascularized by robot-assisted vs conventional standard coronary artery bypass graft surgeries in real-world practice. Medicine (Baltimore), 2021, 100(3): e23830.
15. Bhatt HV, Schuessler ME, Torregrossa G, et al. Robotic cardiac surgery part Ⅱ: Anesthetic considerations for robotic coronary artery bypass grafting. J Cardiothorac Vasc Anesth, 2020, 34(9): 2484-2491.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Robot-assisted bilateral internal mammary arteries harvesting for off-pump coronary artery bypass grafting with 5 grafts by minimally invasive small incision: A case report

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