JTCS Click here to go to SJM website.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Bob Kiaii
R. Scott McClure
Reiza Rayman
Stuart A. Swinamer
Yoshihiro Suematsu
Jennifer Higgins
Philip Jones
John Murkin
Davy Cheng
Richard J. Novick
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kiaii, B.
Right arrow Articles by Novick, R. J.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Kiaii, B.
Right arrow Articles by Novick, R. J.
Related Collections
Right arrow Coronary disease
Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2008;136:702-708
© 2008 The American Association for Thoracic Surgery

Evolving Technology

Simultaneous integrated coronary artery revascularization with long-term angiographic follow-up

Bob Kiaii, MD, FRCSCa,*, R. Scott McClure, MDa, Peter Stewart, MBBS, FRACPb, Reiza Rayman, MDa, Stuart A. Swinamer, MDa, Yoshihiro Suematsu, MDa, Stephanie Fox, RRTa, Jennifer Higgins, BSca, Caroline Albion, BSca, William J. Kostuk, MD, FRCPCb, David Almond, MD, FRCPCb, Kumar Sridhar, MD, FRCPCb, Patrick Teefy, MD, FRCPCb, George Jablonsky, MD, FRCPCb, Pantelis Diamantouros, MD, FRCPCb, Wojciech B. Dobkowski, MD, FRCPCc, Philip Jones, MD, FRCPCc, Daniel Bainbridge, MD, FRCPCc, Ivan Iglesias, MDc, John Murkin, MD, FRCPCc, Davy Cheng, MD, FRCPCc, Richard J. Novick, MD, FRCSC, FACSa

a Department of Surgery, University of Western Ontario, London Health Sciences Centre, University Hospital, Ivey Cardiac Centre, London, Ontario, Canada
b Department of Medicine, University of Western Ontario, London Health Sciences Centre, University Hospital, Ivey Cardiac Centre, London, Ontario, Canada
c Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London Health Sciences Centre, University Hospital, Ivey Cardiac Centre, London, Ontario, Canada

Received for publication June 17, 2007; revisions received January 25, 2008; accepted for publication February 15, 2008.

* Address for reprints: Bob Kiaii, MD, FRCSC, London Health Sciences Centre, University Hospital, 339 Windermere Rd, London, Ontario, Canada, N6A 5A5. (Email: bob.kiaii{at}lhsc.on.ca).

Objective: Traditionally integrated coronary artery revascularization has been described as a 2-stage procedure. We evaluated the safety and feasibility of 1-stage, simultaneous, hybrid, robotically assisted coronary artery bypass grafting surgery and percutaneous coronary intervention.

Methods: Fifty-eight patients underwent simultaneous, integrated coronary artery revascularization in an operating theater equipped with angiographic equipment. Forty-five patients were men. The mean age was 59 years. All internal thoracic arteries were harvested with robotic assistance. All anastomoses were manually constructed through a small anterior non–rib-spreading incision without cardiopulmonary bypass on the beating heart. Immediately after and within the same operative suite, both angiographic confirmation of graft patency and percutaneous coronary intervention were performed. In 52 patients therapeutic anticoagulation was achieved with the direct thrombin inhibitor bivalirudin.

Results: There were no deaths or wound infections. There was 1 perioperative myocardial infarction. One patient had a stroke, and 3 patients required re-exploration for bleeding. The median lengths of intensive care and hospital stay were 1 and 4 days, respectively. All patients were alive and symptom free at follow-up (mean, 20.2 months; range, 1.1–40.8 months). Long-term angiographic follow-up in 54 patients showed 49 (91%) patent grafts (mean, 9.0 months; range, 4.3–40.8 months). There were 7 in-stent restenoses and 2 occluded stents.

Conclusion: For multivessel coronary artery disease, simultaneous integrated coronary artery revascularization with bivalirudin is safe and feasible. This approach enables complete multivessel revascularization with decreased surgical trauma and postoperative morbidity. Further studies are necessary to better determine patient selection and long-term outcomes.

Abbreviations and Acronyms ACT = activated clotting time; ASA = acetylsalicylic acid; BMS = bare-metal stent; CABG = coronary artery bypass grafting; DES = drug-eluting stent; endoACAB = endoscopic atraumatic coronary artery bypass; ICR = integrated coronary revascularization; ICS = intercostal space; ICU = intensive care unit; LAD = left anterior descending coronary artery; LITA = left internal thoracic artery; PCI = percutaneous coronary intervention; TIMI = Thrombolysis In Myocardial Infarction




This article has been cited by other articles:


Home page
 ICVTSHome page
P. Modi, E. Rodriguez, and W. R. Chitwood Jr.
Robot-assisted cardiac surgery
Interactive CardioVascular and Thoracic Surgery, September 1, 2009; 9(3): 500 - 505.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. Gao, M. Yang, Y. Wu, G. Wang, C. Xiao, H. Liu, and C. Lu
Hybrid coronary revascularization by endoscopic robotic coronary artery bypass grafting on beating heart and stent placement.
Ann. Thorac. Surg., March 1, 2009; 87(3): 737 - 741.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The American Association for Thoracic Surgery.