On-Pump Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting: An Animal Study

Abstract

Background Total endoscopic coronary artery bypass grafting (TECAB) is currently performed exclusively with the help of a telemanipulator. After extensive practice in a biomechanical model, the operation was performed as a nonrobotic approach in an animal study.

Methods Six large domestic pigs were anesthetized and intubated. Port access and endoscopic vision were used exclusively during the intrathoracic procedure. In five animals, an internal mammary artery was harvested, extracorporeal circulation was established via peripheral vessel access, and the ascending aorta occluded with an intraluminal balloon. In cardioplegic arrest, an anastomosis of internal mammary artery and left anterior descending coronary artery was performed with shortened 7–0 monofil thread running suture. As a terminal study, the animals were humanely killed and the quality of the anastomoses was checked.

Results After a steady learning curve, the fifth animal was operated on successfully and a satisfactory anastomosis was documented.

Conclusion Despite demanding differences to humans as shape of thoracic cavity and size of peripheral access vessels, the viability of the nonrobotic TECAB concept was documented in a living animal model.

Keywords

TECAB - animal study - intraluminal aortic balloon occlusion

Note Added in Proof

Meanwhile, two patients were operated on successfully with this technique at University Hospital of Ulm, Germany.

• References

• 1 Boyd WD, Desai ND, Kiaii B , et al. A comparison of robot-assisted versus manually constructed endoscopic coronary anastomosis. Ann Thorac Surg 2000; 70 (3) 839-842 , discussion 842–843
• 2 Mack MJ, Acuff TE, Casimir-Ahn H, Lönn UJ, Jansen EW. Video-assisted coronary bypass grafting on the beating heart. Ann Thorac Surg 1997; 63 (6, Suppl): S100-S103
• 3 Watanabe G, Takahashi M, Misaki T, Kotoh K, Doi Y. Beating-heart endoscopic coronary artery surgery. Lancet 1999; 354 (9196) 2131-2132
• 4 Tomita S, Watanabe G, Tabata S, Nishida S. Total endoscopic beating-heart coronary artery bypass grafting using a new 3D imaging system. Innovations (Phila) 2006; 1 (5) 243-246
• 5 Gorki H, Patel NC, Liewald C, Wildhirt S, Subramanian VA, Liebold A. A step toward nonrobotic total endoscopic coronary bypass grafting: 40 coronary anastomoses in a biomechanical beating heart model. Innovations (Phila) 2012; 7 (5) 359-367
• 6 Guide for the Care and Use of Laboratory Animals. 1996 . Available at: www.nap.edu/catalog/5140.htlm [Accessed February 19, 2015]
• 7 Hrapkowicz T, Bisleri G. Endoscopic harvesting of the left internal mammary artery. Ann Cardiothorac Surg 2013; 2 (4) 565-569
• 8 Mohr FW, Morice MC, Kappetein AP , et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381 (9867) 629-638
• 9 Gründeman PF, Budde R, Beck HM, van Boven WJ, Borst C. Endoscopic exposure and stabilization of posterior and inferior branches using the endo-starfish cardiac positioner and the endo-octopus stabilizer for closed-chest beating heart multivessel CABG: hemodynamic changes in the pig. Circulation 2003; 108 (Suppl. 01) II34-II38