Endoscopic Robotically Assisted Coronary Artery Bypass Anastomosis on the Beating Heart: Analysis of Quality and Patency

Abstract

Background: Construction of a coronary artery bypass anastomosis on the beating heart using a computer-enhanced telemanipulation system is feasible but its quality is unknown. Methods: In nine pigs the Left Internal Mammary Artery (LIMA) to the Left Anterior Descending (LAD) coronary artery anastomosis was constructed exclusively using the ZEUS System. Pressure-fixation stabilizer provided local immobilization. LIMA flow was analyzed using transit-time technology. Pigs had to survive without ischemia with proximal LAD ligated for one hour. Angiography was performed within 90 minutes of the anastomosis and graded using the Fitzgibbon Classification. After sacrifice, the anastomosis was assessed using probes. Results: LIMA-LAD anastomosis was successful in all cases in 22 ± 3.6 minutes. No repair stitches were necessary. LIMA flow was 21.6 ± 2.5 ml/min. Angiographic patency was 100% with grade A anastomosis in all. Eight pigs survived without ischemia for 60 min; one pig fibrillated shortly after completion of anastomosis. A 2 mm probe was passed without resistance through the anastomosis in all cases. Conclusion: The quality of the LIMA-LAD anastomosis performed on the beating heart using the ZEUS robotic system is excellent. Confirmation of these results with a totally endoscopic approach is warranted.