Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Ann Thorac Surg. 2012 Dec;94(6):1920-6; discussion 1926. doi: 10.1016/j.athoracsur.2012.05.041. Epub 2012 Oct 25.
Hybrid coronary revascularization combines minimally invasive coronary artery bypass grafting and catheter-based interventions. This treatment option represents a viable alternative to both open multivessel coronary bypass surgery through sternotomy and multivessel percutaneous coronary intervention. The surgical component of hybrid coronary intervention can be offered in a completely endoscopic fashion using robotic technology. We report on one of the largest series to date.
From 2001 to 2011, 226 patients (age, 61 years [range, 31 to 90 years]; 77.0% male; EuroSCORE, 2 [range, 0 to 13]) underwent hybrid coronary interventions on an intention-to-treat basis. Robotically assisted procedures were performed using the daVinci, daVinci S, and daVinci Si surgical telemanipulation systems (Intuitive Surgical, Inc, Sunnyvale, CA) and included 147 single, 72 double, and 7 triple endoscopic coronary artery bypass grafting procedures. Surgery was carried out first in 160 cases (70.8%), percutaneous coronary intervention was carried out first in 38 cases (16.8%), and 28 patients underwent simultaneous operations in a hybrid operating room (12.4%). Drug-eluting stents were used in 70.0% of the patients.
Hospital mortality was 3 of 226 patients (1.3%), and hospital stay averaged 6 days (range, 3 to 54 days). Patients walked outside 7 days (range, 3 to 97 days) postoperatively and performed general household work 14 days (range, 7 to 180 days) postoperatively. Full activity was resumed at 42 days (range, 7 to 720 days). Five-year survival was 92.9%, and 5-year freedom from major adverse cardiac and cerebral events was 75.2%. At 5 years, 2.7% of bypass grafts and 14.2% of percutaneous coronary intervention targets needed reintervention.
Robotically assisted hybrid coronary intervention enables surgical treatment of multivessel coronary artery disease with minimal trauma. Perioperative results and intermediate-term outcomes meet the standards of open coronary artery bypass grafting. Recovery time is short, and reintervention rates are acceptable.
杂交冠状动脉血运重建术将微创冠状动脉旁路移植术与基于导管的介入治疗相结合。这种治疗选择是经胸骨切开的开放多血管冠状动脉旁路移植术和多血管经皮冠状动脉介入治疗的可行替代方案。杂交冠状动脉介入术的手术部分可以使用机器人技术以完全内窥镜的方式提供。我们报告了迄今为止最大的系列之一。
2001 年至 2011 年,226 名患者(年龄 61 岁[范围 31 至 90 岁];77.0%为男性;EuroSCORE 2[范围 0 至 13])按意向治疗原则接受了杂交冠状动脉介入治疗。机器人辅助手术使用达芬奇、达芬奇 S 和达芬奇 Si 手术远程操控系统(Intuitive Surgical,Inc.,加利福尼亚州森尼韦尔)进行,包括 147 例单支、72 例双支和 7 例三支内镜冠状动脉旁路移植术。160 例(70.8%)先进行手术,38 例(16.8%)先进行经皮冠状动脉介入治疗,28 例在杂交手术室同时进行(12.4%)。70.0%的患者使用药物洗脱支架。
226 例患者中有 3 例(1.3%)住院死亡,平均住院时间为 6 天(范围 3 至 54 天)。患者术后 7 天(范围 3 至 97 天)可在室外行走,术后 14 天(范围 7 至 180 天)可进行一般家务劳动。42 天(范围 7 至 720 天)后可恢复正常活动。5 年生存率为 92.9%,5 年无重大心脏和脑不良事件发生率为 75.2%。5 年时,2.7%的旁路移植血管和 14.2%的经皮冠状动脉介入治疗靶血管需要再次介入治疗。
机器人辅助杂交冠状动脉血运重建术可微创治疗多支冠状动脉疾病。围手术期结果和中期结果符合开放冠状动脉旁路移植术的标准。恢复时间短,再次介入率可接受。