Is There a Role for Diagonal Coronary Artery Stenting in Patients Undergoing Robotic Coronary Artery Bypass Graft Surgery?

Abstract

BackgroundThe efficacy of diagonal coronary artery stenting in patients undergoing robotic left internal thoracic artery-to-left anterior descending (LITA-to-LAD) anastomosis is not well defined. The objective of this study was to assess graft and stent patency in a single-stage hybrid revascularization with LITA-to-LAD anastomosis and PCI to a diagonal coronary artery.MethodsFrom 2004 to 2014, a total of 25 patients consented to robotic-assisted LITA harvesting and a small left anterior thoracotomy for off-pump coronary artery bypass anastomosis onto the LAD along with concomitant PCI to the diagonal coronary artery. PCI to the diagonal coronary artery was performed in the same fluoroscopy-equipped hybrid operating room.ResultsPatients were on average 66 ± 11 years with 32% female. Pre-operative characteristics of these patients included 8% with a grade 3 or 4 left ventricle, 16% with a recent MI, and 92% with CCS III/IV symptoms. There were no death, one patient required an intra-aortic balloon pump, and one patient required re-operation for bleeding. The average ICU stay was 1.1 ± 0.53 days, and the average hospital stay was 4.6 ± 2.4 days. Fitzgibbon Grade A LITA-to-LAD patency at 6-month follow-up was 100%. As well, at 6-month follow-up the DES to the diagonal coronary artery had a patency rate of 96%.ConclusionsSingle-stage hybrid revascularization strategy for bifurcating lesions of the LAD and diagonal coronary arteries with LITA-to-LAD anastomosis and PCI to a diagonal coronary artery appears to have acceptable clinical results with excellent 6-month angiographic patency results.

Do the Paths of Sequential Vein Grafts Influence the Outcomes of Coronary Artery Bypass Surgeries?

“…The outcomes and the advantages of SVG have been demonstrated by past research [An 2018;Christenson 1997;Xiao 2015;Kim 2011;Ouzounian 2010]. Similarly, the risk factors that may influence the patency of GSV grafts also have been thoroughly investigated.…”

“…Nonetheless, the results of this study did not indicate that D1 bypass grafting brought any additional benefits. It may possible to partially explain these results based on previous research which found that if the diagonal branch did not have significant stenosis, then the flow of a diagonal branch bypass graft may compete with that of a LIMA graft [Koyama 2014;Nagendran 2018]. However, in cases of unsatisfactory LIMA to LAD bypass grafting that may be due to the poor quality of the LIMA graft or hostile LAD anatomy, or to a bifurcating lesion of the LAD and diagonal branch, sequential bypass grafting to the diagonal branch should be a reasonable choice [Nagendran 2018;Yajima 2017].…”

“…Aside from left anterior descending artery (LAD) bypass grafting, the use of the great saphenous vein (GSV) for the bypass grafting of the other coronary branches is a common method of treatment for multi-vessel coronary disease. The means by which GSV grafts are anastomosed to the coronary arteries include the use of individual vein grafts and sequential vein grafts (SVGs), and previous studies have proven that SVGs result in non-inferior outcomes and better blood flow than individual vein grafts [An 2018;Christenson 1997;Xiao T he Heart Surgery Forum #2019-2729, 2020 [Epub January 2020] doi: 10.1532/hsf.2729 Do the Paths of Sequential Vein Grafts Influence the Outcomes of Coronary Artery Bypass Surgeries?…”

A robotic‐assisted hybrid coronary revascularization program: Establishment and early experience in the Middle East

“…This in turn leads to faster postoperative recovery and a return to baseline activities. [1][2][3]5,[8][9][10] Moreover, cardiopulmonary bypass (CPB) is avoided, thus leading to a reduction in invasiveness and associated systemic inflammation. 11 Additionally, the possibility of adopting robotic technologies in these procedures decreased the risk of vessel injury during left internal mammary artery (LIMA) harvesting process.…”

“…Due to the avoidance of sternotomy, there is a reduction in blood transfusion requirement, shorter intensive care unit (ICU) and hospital stay, lower time on mechanical ventilation, very low morbidity rate. This in turn leads to faster postoperative recovery and a return to baseline activities 1–3,5,8–10 . Moreover, cardiopulmonary bypass (CPB) is avoided, thus leading to a reduction in invasiveness and associated systemic inflammation 11 .…”