Robotic Totally Endoscopic Coronary Artery Bypass for Advanced Hybrid Coronary Revascularization in Patients With Triple Vessel Disease

This article is part of CTSNet’s Guest Editor Series, “Robotic-Assisted Coronary Artery Bypass Graft Surgery—Techniques and Procedures” Dr. M. M. Yusuf brought together cardiac surgery experts from around the world to contribute procedure videos on various techniques.

Advanced hybrid coronary revascularization (AHCR) combines sternal-sparing multivessel coronary artery bypass grafting with percutaneous coronary intervention to treat patients with multivessel coronary artery disease. A fifty-nine-year-old patient with triple vessel disease involving the left anterior descending artery (LAD), left circumflex artery (LCx) and right coronary artery (RCA) was managed with AHCR. This video demonstrates the technique of totally endoscopic coronary artery bypass (TECAB) with the bilateral internal thoracic artery (BITA) to the LAD/LCx. Evidence suggests that BITA grafting results in better long-term outcomes than single internal thoracic artery. This benefit can be extended even to high-risk patients. Robotic-assisted TECAB is the least invasive form of CABG available to date with good outcomes in experienced hands. Unlike traditional surgery, TECAB avoids splitting the sternum, reduces recovery time, and the risk of post-surgical complications, such as sternal wound infections, while offering quick functional recovery. Robotic-assisted CABG is technically challenging and has a long learning curve. 

References

1. Balkhy HH, Nisivaco S, Kitahara H, AbuTaleb A, Nathan S, Hamzat I. Robotic advanced hybrid coronary revascularization: Outcomes with two internal thoracic artery grafts and stents. JTCVS Tech. 2022;16:76-88. Published 2022 Aug 27. doi:10.1016/j.xjtc.2022.08.012.
2. Balkhy HH, Nisivaco S, Kitahara H, et al. Robotic off-pump totally endoscopic coronary artery bypass in the current era: report of 544 patients. Eur J Cardiothorac Surg. 2022;61(2):439-446. doi:10.1093/ejcts/ezab378.
3. Balkhy HH. Robotic totally endoscopic coronary artery bypass grafting: It's now or never!. JTCVS Tech. 2021;10:153-157. Published 2021 Apr 10. doi:10.1016/j.xjtc.2021.03.037.

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