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ABSTRACT 103
CORONARY ARTERY BYPASS ON THE BEATING HEART USING
A TELEROBOTIC SYSTEM
Marco Zenati, Larry Nichols, William Wagner, Bartley Griffith.
Div Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh
Pennsylvania, USA
Objective: To evaluate the quality of Left Internal Thoracic
Artery (LITA) to Left Anterior Descending (LAD) coronary artery
anastomosis performed on the beating heart using a 4 degrees of
freedom (DOF) robotic telemanipulation system (ZEUS, ComputerMotion,
Goleta, CA, USA).
Methods. Nine crossbred swine were used. LITA was mobilized
manually through a median sternotomy. Three 5 mm ports were created
on the left chest for the 2D camera and left and right ZEUS telemanipulator
arms. Mechanical immobilization of the LAD was achieved with the
ATLAS endoscopic stabilizer. Intracoronary shunts were used in
all cases. Anastomotic quality was assessed by transit time flow
analysis, survival, angiography and probing. Histopathological
analysis was performed in 7/9 samples; the remaining two samples
underwent scanning electron microscopy.
Results. All 9 anastomosis were completed with success
in 22 + 3.6 minutes. LITA flow was 21.6 + 2.5 mL/min.
8 pigs survived for 1 hour with the LAD proximally ligated without
EKG changes; one pig fibrillated after reperfusion. Angiographic
patency was 100% (9/9) with Fitzgibbon grade A in all. A 2 mm
probe was passed into the anastomosis in all cases without resistance.
Upon gross inspection, no evidence of thrombus at the anastomotic
site was identified. Histopathology demonstrated integrity of
the internal elastic lamina for > 90% of the circumference
and absence of medial necrosis or infiltration by PMNs in all
samples. Platelet deposition at the anastomosis was moderate in
4 and mild in 3.
Conclusions. LITA-LAD coronary bypass grafting is feasible
on the stabilized beating heart using a 4 DOF robotic telemanipulation
system and is associated with excellent quality of the anastomosis.
These results supports continued investigation toward endoscopic
robotically-assisted beating heart CABG.
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