We conclude that technical difficulties during totally endoscopic coronary artery bypass grafting translate into markedly increased operative time, moderately prolonged postoperative ventilation time, and slightly increased hospital stay. Short-term survival and freedom from angina, however, do not seem to be compromised.

We conclude that intraoperative screening of coronary artery bypass grafting patients by epiaortic scanning can reveal useful information about the operative risk and with an aortic no-touch concept, perioperative stroke rates in high-risk patients may be lower than predicted.

We present our initial experience with intraoperative angiographic evaluation of coronary artery bypass grafts placed on the beating heart. Thirty-three grafts were investigated in 23 patients. Transfemoral angiography was performed using an OEC 9800 mobile C-arm. Spasm of the graft and/or target vessel was present in 11 grafts, two grafts were severely stenosed requiring surgical revision. In a third case an additional bypass graft was placed due to angiography findings. There was no hospital mortality and no significant perioperative myocardial ischemic event. All patients were free of angina 6 months postoperatively. Intraoperative angiography seems to reveal valuable information in beating heart coronary surgery.

We conclude that despite being surgically challenging robotically assisted coronary artery surgery can be implemented with acceptable safety. TECAB procedures have reached a reproducible state. Perioperative mortality after robotically assisted CABG may be lower than predicted. Intermediate term clinical results are very satisfactory.

Planning hybrid coronary artery revascularization--a combination of cardiac surgery with percutaneous procedures--requires, at first sight, a very complex logistical setup. Technical and equipment related details should be defined as early as possible in order to have time for training of all OR personnel involved. The most challenging aspect in OR-located hybrid coronary revascularization remains a very close cooperation of cardiac surgeons and interventional cardiologists. This teamwork does include indication findings and subsequent referral of multivessel coronary artery disease patients to hybrid procedures, as well as high individual flexibility of interventionalists and surgeons. The major prerequisite for this cooperation is a mutual acceptance of different revascularization approaches and the intent to combine their most striking advantages. Intraoperative graft angiography during coronary artery bypass grafting (CABG) procedures is one important step toward simultaneous hybrid coronary revascularization procedures. We describe our experience with on table angiography using a mobile C-arm for intraoperative imaging. This fluoroscopy system can in selected cases be used for simultaneous hybrid procedures.