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Initial experience with internal mammary artery harvesting with the da Vinci Surgical System for minimally invasive direct coronary artery bypass

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Abstract

Purpose

We evaluated the feasibility of off-pump minimally invasive direct coronary artery bypass (MIDCAB) in combination with robotic harvesting of the left internal mammary artery (LIMA).

Methods

Since 2004, 33 patients [average age, 64 years; 27 males (82 %)] have undergone MIDCAB with robotic LIMA harvesting performed through the fourth or fifth intercostal space with guidance by enhanced computed tomography (CT).

Results

No deaths or major adverse cardiac events occurred. Robotic LIMA harvesting was completed in 30 cases (91 %), while three cases (9 %) required conversion to a median sternotomy due to bleeding. The risk of LIMA injury significantly increased with age (p = 0.0012). For the 30 successful cases, the average harvest time was 68 min, and the average intraoperative blood loss was 306 ml, with only three patients (9 %) requiring a transfusion. The graft flow was measurable in all cases (average, 34 ml/minute). All grafts were shown to be patent in postoperative evaluations, although CT revealed that the LIMA in one patient was anastomosed to an untargeted artery.

Conclusions

Off-pump MIDCAB in combination with robotic harvesting of the LIMA is a reasonable and less invasive procedure than the standard procedures. Potential problems include difficulty controlling bleeding from the graft, especially in elderly patients, and proper identification of the target artery.

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Conflict of interest

T. Fujita and co-authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan

    Tomoyuki Fujita, Hiroki Hata, Yusuke Shimahara, Shunsuke Sato & Junjiro Kobayashi

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  1. Tomoyuki Fujita
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  2. Hiroki Hata
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  3. Yusuke Shimahara
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  4. Shunsuke Sato
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  5. Junjiro Kobayashi
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Correspondence to Tomoyuki Fujita.

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Fujita, T., Hata, H., Shimahara, Y. et al. Initial experience with internal mammary artery harvesting with the da Vinci Surgical System for minimally invasive direct coronary artery bypass. Surg Today 44, 2281–2286 (2014). https://doi.org/10.1007/s00595-013-0830-z

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  • DOI: https://doi.org/10.1007/s00595-013-0830-z

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