Yang Ming, Gao Chang-qing, Wu Yang, Wang Gang, Xiao Cang-song, Wang Rong
Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2013 Feb 5;93(6):428-31.
To summarize our experience of robotic internal thoracic artery (ITA) skeletonized harvesting in Asian patients and evaluate the learning curves of robotic ITA harvesting and ITA graft patency.
A total of 200 patients underwent totally robotic ITA takedown at our department from April 2007 to August 2012. ITA was harvested in a skeletonized fashion and learning curve estimated. Coronary artery bypass grafting was completed in minimally invasive direct coronary artery bypass graft (MIDCAB) or totally endoscopic coronary bypass graft on beating heart (BH-TECAB) manners after robotic ITA harvesting. The coronary angiography or 64-MSCT was performed to evaluate the patency of ITA graft before discharge and at Year 1-5 postoperatively.
One patient underwent median sternotomy for severe plural adhesion. Left ITA (LITA, n = 190), right ITA (RITA, n = 5) and double-ITA (n = 4) were harvested. The mean duration of single ITA harvesting was 18-70 (35.8 ± 10.7) min. A significant learning curve was observed: y (min) = 58.0 - 5.3×ln(x) (r(2) = 0.33, P < 0.01). ITA patency was 98.1% at Year 1 and 97.8% at Year 2 postoperatively respectively. And there was no recurrence of ITA occlusion at Years 3-5.
Robotic ITA takedown is a prerequisite for totally endoscopic coronary bypass graft and can be performed safely and within an acceptable time after overcoming a learning curve. ITA graft patency has comparable outcomes of conventional surgery.
总结我们在亚洲患者中进行机器人游离胸廓内动脉（ITA）采集的经验，并评估机器人ITA采集的学习曲线以及ITA移植物的通畅率。
2007年4月至2012年8月期间，共有200例患者在我科接受了完全机器人ITA游离术。以游离的方式采集ITA并估计学习曲线。在机器人ITA采集后，以微创直接冠状动脉旁路移植术（MIDCAB）或心脏不停跳完全内镜冠状动脉旁路移植术（BH-TECAB）的方式完成冠状动脉旁路移植术。在出院前及术后1至5年进行冠状动脉造影或64层螺旋CT检查，以评估ITA移植物的通畅情况。
1例患者因严重胸膜粘连接受了正中胸骨切开术。采集了左ITA（LITA，n = 190）、右ITA（RITA，n = 5）和双ITA（n = 4）。单次ITA采集的平均时长为18 - 70（35.8 ± 10.7）分钟。观察到明显的学习曲线：y（分钟）= 58.0 - 5.3×ln(x)（r(2) = 0.33，P < 0.01）。术后1年ITA通畅率为98.1%，术后2年为97.8%。在第3至5年没有ITA闭塞复发。
机器人ITA游离术是完全内镜冠状动脉旁路移植术的前提条件，克服学习曲线后可在可接受的时间内安全进行。ITA移植物通畅率与传统手术相当。
