Balkhy Husam H, Kitahara Hiroto, Mitzman Brian, Nisivaco Sarah
Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago Medicine, Chicago, IL, USA.
Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, USA.
Eur J Cardiothorac Surg. 2020 Mar 1;57(3):529-534. doi: 10.1093/ejcts/ezz283.
Left coronary vessels are the usual targets in totally endoscopic coronary artery bypass (TECAB). Grafting of the right coronary artery (RCA) has been limited using this approach because of anatomic and technical difficulties. We report a first series of robotic beating-heart TECAB to the RCA via a right-chest approach.
From July 2013 to April 2019, patients who underwent robotic beating-heart TECAB with the right internal mammary artery to the RCA were reviewed. Port placement in the right chest mirrored standard left-sided ports. Indications for right internal mammary artery to RCA bypass were RCA disease not amenable to percutaneous intervention and anomalous origin of the RCA.
Right internal mammary artery-RCA bypass was performed in 16 patients (mean age 60.6 ± 13.5, 75% male). All cases were completed without conversion to sternotomy or mini-thoracotomy. Cardiopulmonary bypass was required in 1 patient to expose the posterior descending artery. Mean procedure time was 223 ± 49 min, with half of the patients extubated in the operating room (50%). Mean intraoperative transit-time graft flow was 87.0 ± 19.3 ml/min, and a pulsatility index of 1.2 ± 0.2. Mean length of stay was 2.3 ± 1.2 days. No mortality was observed at mean follow-up time of 20.6 months. One patient required repeat RCA revascularization for progression of native disease 43.7 months after the surgery.
Robotic beating-heart TECAB for isolated RCA disease is a feasible operation in selected patients. This technique is possible even for the posterior descending artery.
在完全内镜冠状动脉搭桥术（TECAB）中，左冠状动脉血管通常是手术目标。由于解剖学和技术上的困难，使用这种方法进行右冠状动脉（RCA）搭桥一直受到限制。我们报告了首例通过右胸入路进行的机器人辅助不停跳TECAB治疗RCA的系列病例。
回顾2013年7月至2019年4月期间接受机器人辅助不停跳TECAB并使用右乳内动脉至RCA搭桥的患者。右胸的端口放置与标准左侧端口相对应。右乳内动脉至RCA搭桥的指征为不适合经皮介入治疗的RCA疾病以及RCA异常起源。
16例患者（平均年龄60.6±13.5岁，75%为男性）接受了右乳内动脉至RCA搭桥手术。所有病例均未转为胸骨切开术或小切口开胸手术。1例患者需要体外循环以暴露后降支动脉。平均手术时间为223±49分钟，50%的患者在手术室拔管。平均术中移植血管血流通过时间为87.0±19.3毫升/分钟，搏动指数为1.2±0.2。平均住院时间为2.3±1.2天。平均随访20.6个月时未观察到死亡病例。1例患者在术后43.7个月因原发病进展需要再次进行RCA血运重建。
对于孤立性RCA疾病，机器人辅助不停跳TECAB在选定患者中是一种可行的手术。即使对于后降支动脉，这种技术也是可行的。
