Robot-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting - ThoraCAB -
Robot-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting - ThoraCAB -
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DOI：
10.1253/circj.cj-13-1115
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发表时间：
2014-02-01
影响因子：
3.3
通讯作者：
Iino, Kenji
中科院分区：
文献类型：
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作者：
Ishikawa, Norihiko;Watanabe, Go;Iino, Kenji
背景：本研究的目的是评估机器人辅助微创直接冠状动脉旁路移植术（MIDCAB）的结果，也称为ThoraCAB。方法和结果：从2005年到2013年，连续35例患者通过小开胸对跳动的心脏进行了MIDCAB。在进行MIDCAB之前，使用达芬奇手术系统以完全骨架化的方式通过3个端口在内窥镜下切除胸内动脉（ita）。远端吻合采用真空稳定器手工缝合，冠脉主动灌注系统防止吻合过程中心肌缺血。所有患者均成功完成机器人辅助ITA采集。平均每名患者进行1.7 +/- 0.8次移植（范围1-3次）。无患者需要机械通气超过24小时。没有死亡、中风或心肌梗死，没有患者需要转至正中胸骨切开术。结论：机器人辅助ITA采集是安全可行的。ThoraCAB是一个相对简单的手术，允许在小开胸手术后进行多血管旁路移植术。因此，ThoraCAB有望成为微创冠状动脉血运重建术的标准手术，并在未来的全内镜下冠脉搭桥中得到应用。
Background: The aim of this study was to assess the outcome of robot-assisted minimally invasive direct coronary artery bypass grafting (MIDCAB), which is also termed "ThoraCAB".Methods and Results: From 2005 to 2013, 35 consecutive patients underwent MIDCAB via a small thoracotomy on a beating heart. Before performing MIDCAB, the internal thoracic arteries (ITAs) were endoscopically harvested through 3 ports using the da Vinci Surgical System in a completely skeletonized fashion. Distal anastomosis was hand-sewn using a vacuum stabilizer, and a coronary artery active perfusion system was used to prevent myocardial ischemia during anastomosis. Successful robot-assisted ITA harvesting was achieved in all patients. There was an average of 1.7 +/- 0.8 grafts (range, 1-3 grafts) per patient. No patient needed mechanical ventilation for more than 24h. There were no deaths, strokes or myocardial infarctions, and none of the patients required conversion to median sternotomy.Conclusions: Robot-assisted ITA harvesting is safe and feasible. ThoraCAB is a relatively simple procedure and allows multivessel bypass grafting after a small thoracotomy. Therefore, it is expected that ThoraCAB will become the standard procedure for minimally invasive coronary revascularization and will be used in totally endoscopic CABG in the future.