Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey.
Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey.
Innovations (Phila). 2024 Jan-Feb;19(1):30-38. doi: 10.1177/15569845231213038. Epub 2023 Dec 19.
Robot-assisted minimally invasive coronary bypass surgery is one of the least invasive approaches that offers multivessel revascularization and accelerated recovery. We investigated the benefits of computed tomography angiography (CTA) guidance in robotic coronary bypass (RCAB) by analyzing perioperative outcomes.
Between April 2022 and April 2023, 60 consecutive patients who underwent RCAB under preoperative CTA guidance were included. The intercostal space of the minithoractomy incision was determined based on the distance from the thoracotomy site to the midsection of the left anterior descending artery (LAD) on preoperative CTA. Peripheral vascular findings on preoperative CTA guided the decision for the cannulation site. Perioperative parameters and early outcomes were evaluated.
The mean age of the patients was 62.3 ± 10.5 years, and 51 patients were male (85.0%). The mean number of revascularized vessels was 2.9 ± 1.1. Left thoracotomy guided by CTA measurements was performed in the fourth intercostal space in 37 patients (61.7%) and in the third intercostal space in the remaining patients. Axillary cannulation was performed in 28 (46.7%) patients because of prohibitive findings in the iliac vessels and aorta. All target coronary arteries with an indication for bypass were revascularized with CTA-guided RCAB. The left internal mammary artery (LIMA) was anastomosed to the LAD in all patients, and the LIMA was anastomosed sequentially to the diagonal artery in 17 patients (28.3%). No operative mortality or cerebrovascular event was observed. One patient underwent reoperation due to bleeding.
Robot-assisted minimally invasive multiple-vessel coronary bypass under preoperative CTA guidance is safe and can be performed with excellent results.
机器人辅助微创冠状动脉旁路移植术是一种侵袭性最小的方法，可提供多血管血运重建和加速康复。我们通过分析围手术期结果，研究了计算机断层血管造影 (CTA) 引导在机器人冠状动脉旁路 (RCAB) 中的益处。
2022 年 4 月至 2023 年 4 月，连续 60 例接受 RCAB 手术的患者，在术前 CTA 引导下进行。根据术前 CTA 上的切口到左前降支（LAD）中段的距离，确定微创开胸切口的肋间间隙。术前 CTA 上的外周血管发现指导套管插入部位的决策。评估围手术期参数和早期结果。
患者的平均年龄为 62.3±10.5 岁，51 例为男性（85.0%）。平均血管重建数量为 2.9±1.1 条。37 例（61.7%）患者在第四肋间进行 CTA 测量引导的左开胸，其余患者在第三肋间进行开胸。由于髂血管和主动脉的禁忌发现，28 例（46.7%）患者进行腋动脉插管。所有有旁路适应证的靶冠状动脉均通过 CTA 引导的 RCAB 进行血运重建。所有患者均将左内乳动脉（LIMA）吻合至 LAD，17 例（28.3%）患者将 LIMA 顺序吻合至对角支。无手术死亡或脑血管事件。1 例患者因出血行再次手术。
术前 CTA 引导的机器人辅助微创多血管冠状动脉旁路术是安全的，可以取得优异的效果。
