Presentations

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

International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) - Annual Scientific Meeting
June 1-4, 2005, New York City

Date: June 3, 2005
Title: Single Vessel To Multivessel Beating Heart Totally Endoscopic Coronary Artery Bypass (TECAB). Progress Or Distraction?
Presenters: Sudhir Srivastava, Suresh Gadasalli, Madhava Agusala, Ram Kolluru, Manish Shroff, Reyna Barrera, Shaune Quismundo, Vishwa Srivastava
Alliance Hospital, Odessa, TX

BACKGROUND: Experience in closed chest coronary artery bypass surgery has been increasing worldwide. The present report discusses use of da Vinci Robotic System on a beating heart for totally endoscopic coronary revascularization.

METHODS: From November 2003 to December 2004, 65 patients underwent beating heart TECAB using da Vinci robotic system. Four to five two-centimeter incisions were made for the camera, instrument arms, and stabilizer. Right and/or left internal thoracic arteries were harvested in skeletonized fashion. Telemanipulation of da Vinci surgical instruments on beating heart, Octopus TE stabilizer, and U-Clips facilitated coronary revascularization.

RESULTS: Four patients were excluded intra-operatively and four patients were converted to small thoracotomy to complete the anastomoses. Planned revascularization was completed in 57 patients. There was no mortality, MI, or CVA. Six patients developed new onset atrial fibrillation. Mean anastomosis time for single vessel and multivessel TECAB was 17.8 +/- 8.9 minutes and 14.2 +/- 4.5 minutes respectively. Mean operative time was 318.2 +/- 112.2 minutes. Mean length of hospital stay was 2.5 +/- 1.8 days. Twelve patients had hybrid procedure. All grafts were patent on post-operative CT angiography or angiography during percutaneous intervention.

CONCLUSION: Robotically assisted coronary revascularization on a beating heart was found to be safe and feasible in this group of patients. The approach facilitates multivessel TECAB in a completely closed chest manner.

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

Date: January 24, 2005
Title: Da Vinci Multivessel Coronary Revascularization on a Beating Heart Initial Clinical Experience
Presenters: S Srivastava¹; Suresh Gadasalli¹; M Agusala¹; M Shroff¹; R Barrera¹; S Quismundo¹; V Srivastava^2
1Alliance Hospital, Odessa, Texas
²Cardiac Surgical Associates, Odessa, Texas

BACKGROUND: Da Vinci robotic system has been used in various cardiac surgical procedures. The present report discusses the initial clinical experience with multivessel coronary revascularization done completely using da Vinci Robotic System.

METHODS: From July 14, 2004 to August 3, 2004, five patients underwent multivessel revascularization using da Vinci Robotic System. Five one to two centimeter incisions were made for the camera, two instrument arms and endoscopic stabilizer. After introducing the camera and two instrument arms, the right and left internal thoracic arteries were harvested in a skeletonized fashion. Multivessel cornary artery bypass grafting was done through telemanipulation of da Vinci surgical instruments on a beating heart with U-Clips.

RESULTS: In four patients LITA was anastomosed to left anterior descending artery (LAD) and RITA to obtuse marginal artery. In one patient LITA and RITA were anastomosed to LAD and right coronary artery respectively. There was no mortality, myocardial infarction, cerebrovascular accident, exploration for post-operative bleeding, and atrial fibrillation. The mean anastomosis time was 15.8+/- 5.3 minutes. Mean operative time was 389.25+/- 37.6 minutes. The mean length of hospital stay was 1.5 +/- 0.3 days. All grafts were patent on post operative CT angiography.

CONCLUSIONS: Multivessel coronary revascularization on a beating heart with robotic assistance was found to be feasible in this group of patients. There was minimal pain observed with a faster functional recovery . Further follow up for long term graft patency is necessary. The approach may allow surgeons to perform multivessel coronary artery bypass graft surgery in a completely closed chest manner.

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.