Presentations

Following are abstracts of presentations made by Dr. Gadasalli and his colleagues during various professional conferences and seminars.

41st Annual Meeting of The Society of Thoracic Surgeons
January 24, 2005-January 26, 2005, Tampa, Florida

Date: January 25, 2005
Title: Use of Bilateral Internal Thoracic Artery in Coronary Artery Bypass Grafts Through Antero-lateral Thoracotomy, Thoracab, Facilitated By Da Vinci Robotic System. Report of First 150 Patients
Presenters: *S Srivastava; Suresh Gadasalli; M Agusala; R Kolluru; J Naidu; M Shroff; R Barrera; S Quismundo; V Srivastava
Alliance Hospital, Odessa, Texas

BACKGROUND: Internal thoracic arteries (ITA) have been shown to offer longer graft patency. CABG through small antero-lateral thoracotomy has been reported. The present study deals with feasibility of BITA in ThoraCAB facilitated by da Vinci.

METHODS: Since July 2002, 150 patients underwent ThoraCAB using da Vinci robotic assistance for harvesting of BITA. The mean age was 67.2 +/- 9.5 years. After single lung ventilation, three one-to-two centimeter incisions were made in the third, fifth, and seventh intercostal spaces (IS) two-to-three centimeters medial to the anterior axillary line. Following insertion of camera and instrument arms, both ITAs were harvested in a completely skeletonized fashion. A small antero-lateral thoracotomy was done enlarging the camera port incision. Distal anastomoses were performed on a beating heart using surgical U-Clips. Intercostal cryo-analgesia and On-Q Pump were used for pain management.

RESULTS: Planned arterial revascularization was completed in 148 patients. Mean number of arterial grafts per patient was 2.6 +/- 0.8. All coronary arteries could be reached with BITA as in situ or composite grafts. There was no mortality, CVA, myocardial infarction, or wound infection. Seven patients developed new onset atrial fibrillation. Four patients required exploration of postoperative bleeding. Mean post-operative length of stay was 3.6 +/- 2.9 days.

CONCLUSIONS: Da Vinci Robotic System was found to be safe and feasible for BITA harvesting in multivessel ThoraCAB. Further follow up for graft patency is necessary. Post-operative pain may be reduced with aggressive management strategies. The approach offers fast recovery. This sternum-sparing approach may be an evolutionary step toward closed-chest CABG.