Robotic total endoscopic double-vessel coronary artery bypass grafting--state of procedure development

Objective: Robotic total endoscopic coronary artery bypass grafting has been under development for 10 years. With increasing experience and technological improvement, double-vessel total endoscopic coronary artery bypass grafting has become feasible. The aim of the present study was to compare the current outcomes of single- and double-vessel total endoscopic coronary artery bypass grafting. Methods: Between 2001 and 2011, 484 patients underwent total endoscopic coronary artery bypass grafting by 4 surgeons at 2 institutions. The median patient age was 60 years (range, 31-90), and the median European System for Cardiac Operative Risk Evaluation was 2 (range, 0-13). Single-vessel (n = 334) and double-vessel (n = 150) procedures were performed using the da Vinci, da Vinci S, and da Vinci Si robotic systems. Results: Compared with the single-vessel procedure, double-vessel total endoscopic coronary artery bypass grafting required a longer operative time (median, 375 minutes; range, 168-795; vs median, 240; range, 112-605; P < .001) and had an increased conversion rate to a larger thoracic incision (31/150 [20.7%] vs 31/334 [9.3%]; P < .001). The median ventilation time was 10 hours (range, 0-288) for double-vessel versus 8 hours (range, 0-278) for single-vessel procedures (P = .006). The hospital stay was comparable, with 6 days (range, 2-27) for double-vessel total endoscopic coronary artery bypass grafting and 6 days (range, 2-33) for single-vessel total endoscopic coronary artery bypass grafting (P =. 794). Perioperative mortality was 0.3% (1/334) with single-vessel total endoscopic coronary artery bypass grafting and 2.0% (3/150) with double-vessel total endoscopic coronary artery bypass grafting (P = .090). Freedom from major adverse cardiac and cerebral events at 5 years was similar after double- and single-vessel total endoscopic coronary artery bypass grafting (73.5% vs 83.1%, P =. 150). The 5-year survival was 95.8% and 93.9% (P =. 708). Conclusions: Double-vessel total endoscopic coronary artery bypass grafting appears feasible and reproducible. The operative times were longer and the conversion rates to a larger thoracic incision were greater than with single-vessel total endoscopic coronary artery bypass grafting. Also, the postoperative ventilation time was longer. Other perioperative morbidity and mortality and the recovery time and long-term clinical outcomes, however, were comparable.