Ten-year Experience and Outcomes of Off-pump Totally Endoscopic Coronary Artery Bypass Grafting For Left Anterior Descending Artery Disease
Changqing Gao, Huajun Zhang, Ming Yang, Rong Wang, Nan Cheng.
PLA General Hospital, Beijing, China.
Objective To summarize the ten-year surgical experience with totally endoscopic coronary artery bypass grafting (TECAB) and demonstrate the long-term clinical and angiographic follow-up results. Methods Between March 2007 and May 2017, a total of 114 consecutive patients ( 96 male) with left anterior descending (LAD) artery disease underwent off-pump TECAB with da Vinci Surgical System (Intuitive Surgical, USA) in our institution. The patients’ average age was 58 years (range, 36 to 78 years) and EuroSCORE of 1.1±1.3. The left internal mammary artery (LIMA) was taken down by using skeletonized method and was anastomosed to the LAD artery with S18 U-clips. The blood flow in the LIMA-LAD graft was measured with Medistim VeriQC system (Medistim ASA, Norway). The patients were followed regularly after surgery and the coronary angiography or CT angiogram (CTA) was performed to evaluate LIMA graft patency. Results All cases (n=114) were successfully performed by single console surgeon with single LIMA graft (100%). No operative death or conversion to median sternotomy happened. The total operation duration was 219 ± 58 min, including LIMA take-down time of 33± 9 min and anastomosing time of 10±4min. The blood flow of LIMA graft was (36.8±18) ml/min after TECAB. One case (0.88%) of re-exploration for bleeding happened after operation. The postoperative ventilation time was 13.9 ± 4.0 hours. The chest draining volume was 417.4 ±274.8 ml. Coronary angiography or CTA showed 100% graft patency before discharge. During the follow-up period (1 to 91 months), no death, myocardial infarction or stroke happened, and 2 (1.75%) patients required re-intervention. CTA showed that 98.8% of the LIMA grafts was patent at 1 year after surgery, and the patency rate was 97.8% at 2 years, and 97.1% at 3 to 5 years after surgery. Conclusions Off-pump TECAB using LIMA to graft LAD is a safe and effective option for LAD single vessel disease and the long-term graft patency is excellent.
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