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Didier de Cannière
Gerhard Wimmer-Greinecker
Romuald Cichon
Vassilios Gulielmos
Frank Van Praet
Volkmar Falk
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J Thorac Cardiovasc Surg 2007;134:710-716
© 2007 The American Association for Thoracic Surgery

Evolving Technology

Feasibility, safety, and efficacy of totally endoscopic coronary artery bypass grafting: Multicenter European experience

Didier de Cannière, MD, PhDa,*, Gerhard Wimmer-Greinecker, MD, PhDb, Romuald Cichon, MDc, Vassilios Gulielmos, MDc, Frank Van Praet, MDd, Usha Seshadri-Kreaden, MScf, Volkmar Falk, MD, PhDe

a Department of Cardiac Surgery at Erasme University Hospital, Brussels, Belgium
b Department of Cardiac Surgery, Klinikum der Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany
c Department of Cardiac Surgery, Dresden Herzzentrum, Dresden, Germany
d Department of Cardiac Surgery, Onze Lieve Vrouwziekenhuis, Aalst, Belgium
e Department of Cardiac Surgery, Leipzig Heart Institute, University of Leipzig, Leipzig, Germany
f Intuitive Surgical Inc, Sunnyvale, Calif.

Received for publication September 27, 2005; revisions received May 16, 2006; accepted for publication June 9, 2006.

* Address for reprints: Didier de Cannière, MD, PhD, Chief of Cardiac Surgery, Erasme University Hospital, Department of Cardiac Surgery, 808 Route de Lennik, 1070 Brussels, Belgium. (Email: didier.decanniere{at}ulb.ac.be).

Objective: The invention of robotic systems has begun a new era of endoscopic cardiac surgery. Reports on totally endoscopic coronary artery bypass grafting are limited, however, and data regarding feasibility, safety, and efficacy are needed to determine this technique’s position in the therapeutic armamentarium. This study describes the largest multicenter experience in the literature with robotic totally endoscopic coronary artery bypass grafting specifically addressing procedural feasibility, safety, and efficacy.

Methods: Between September 1998 and November 2002, a total of 228 patients with coronary artery disease were scheduled for totally endoscopic coronary artery bypass grafting with the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, Calif.) at five European institutions. Patients underwent totally endoscopic coronary artery bypass grafting with either an on-pump (group A, n = 117) or an off-pump approach (group B, n = 111). Patients underwent postoperative angiography or stress electrocardiography and were followed up for 6 months.

Results: Procedural feasibility was demonstrated through the completion of 164 successful totally endoscopic cases. Sixty-four patients (group C, 28%) had conversion to nonrobotic procedures. Conversion rates decreased with time. The overall procedural efficacy, as defined by angiographic patency or lack of ischemic signs on stress electrocardiography, was 97%. The incidence of major adverse cardiac events within 6 months was 5%.

Conclusion: Both on- and off-pump totally endoscopic coronary artery bypass grafting are feasible, with a conversion rate that diminishes with increasing experience. Conversion does not adversely affect outcome and thus constitutes a safe alternative. Although target vessel reintervention may be slightly higher than that reported for open coronary artery bypass grafting, graft patency and major adverse cardiac events for both approaches are comparable to those reported in the Society of Thoracic Surgeons database, demonstrating the safety and efficacy of the totally endoscopic coronary artery bypass grafting procedure.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; CPB = cardiopulmonary bypass; ECG = electrocardiography; MACE = major adverse cardiac event; STS = Society of Thoracic Surgeons; TECAB = totally endoscopic coronary artery bypass grafting


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