ABSTRACT
AIM: This prospective study was performed as a Phase 1 Food and Drug Administration clinical trial to assess the safety and feasibility of robotically assisted coronary artery bypass grafting (CABG). METHODS: Eighteen patients undergoing elective CABG were enrolled in this study. Full sternotomy was performed in 17 of 18 patients, while cardiopulmonary bypass and cardioplegic arrest was used in all cases. Robotically assisted CABG of the left internal thoracic artery (LITA) to the left anterior descending artery (LAD) was performed through three ports using a robotically assisted microsurgical system. Conventional techniques were used to perform all other grafts. Blood flow in the LITA graft was measured in the operating room, and when necessary, angiography was performed. Six weeks after the operation, all patients underwent selective coronary angiography of the LITA graft. RESULTS: Robotically assisted coronary artery anastomoses were successfully completed in all patients. Blood flow through the LITA graft was adequate in 16 of 18 patients (89%). The two inadequate grafts were revised successfully by hand. Six weeks after the operation, angiography demonstrated a graft patency of 100% (13 of 13). Mean follow-up has been over 190 days. All patients remain New York Heart Association Angina Class I. CONCLUSION: Robotic assistance represents an enabling technology that may allow the surgeon to perform endoscopic coronary artery anastomoses. Further clinical trials are needed to explore the clinical potential and value of robotically assisted CABG.
Subject(s)
Coronary Artery Bypass/methods , Robotics , Coronary Artery Bypass/instrumentation , Female , Follow-Up Studies , Humans , Male , Microsurgery/instrumentation , Middle Aged , Operating Rooms , Pilot Projects , Prospective Studies , Surgical Equipment , Time Factors , Vascular PatencyABSTRACT
Multielectrode catheters provide a percutaneous means of recording activation near the epicardium but only for a relatively small number of sites that are restricted to the major coronary vessels. We have applied a statistical signal processing technique to estimate the value of activation time over the entire epicardium (490 sites) from leadsets consisting of 4 to 40 sites aligned with major branches of the coronary veins. We tested this method using data from high-resolution epicardial mapping from six dog hearts and 153 activation sequences. A study including data from both normal and infarcted dog hearts yielded estimates of activation time, with mean correlation coefficients ranging from 0.97 to 0.84 and achieved localization of earliest site of activation to within 3 to 15 mm, depending on training parameters and leadset. These results suggest that with 10 to 15 catheter-mounted electrodes, it may be possible to reconstruct epicardial activation maps from percutaneous recordings.
