Robotic-assisted left thoracic small-incision minimally invasive coronary artery bypass grafting: a case series report

HE Peiling; SONG Yi; YUAN Ye; WU Wenjun; ZHONG Changming; LIU Chang; CHEN Jianming; HU Yijie

doi:10.16016/j.2097-0927.202403028

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Robotic-assisted left thoracic small-incision minimally invasive coronary artery bypass grafting: a case series report

Clinical Medicine | 更新时间：2025-01-23

- Robotic-assisted left thoracic small-incision minimally invasive coronary artery bypass grafting: a case series report
- Journal of Army Medical University Vol. 47, Issue 2, Pages: 161-167(2025)
- 作者机构：
  
  陆军特色医学中心（第三军医大学大坪医院）心脏血管外科，重庆
- 作者简介：
  
  HU Yijie， E-mail： yijie.hu@tmmu.edu.cn
- 基金信息：
  
  the Joint Medical Research Project of Chongqing Science and Technology Commission and Chongqing Health Commission(2024MSXM092)
- DOI：10.16016/j.2097-0927.202403028
  CLC： R616.2;R654.1;R654.2
- Published：30 January 2025，
  
  Received：08 March 2024，
  
  Revised：14 November 2024，
- 稿件说明：
移动端阅览
HE PEILING, SONG YI, YUAN YE, et al. Robotic-assisted left thoracic small-incision minimally invasive coronary artery bypass grafting: a case series report. [J]. Journal of army medical university, 2025, 47(2): 161-167.
DOI：

HE PEILING, SONG YI, YUAN YE, et al. Robotic-assisted left thoracic small-incision minimally invasive coronary artery bypass grafting: a case series report. [J]. Journal of army medical university, 2025, 47(2): 161-167. DOI： 10.16016/j.2097-0927.202403028.

摘要

目的

总结机器人辅助左胸小切口微创冠状动脉旁路移植术（minimally invasive direct coronary artery bypass grafting， MIDCAB）的临床治疗效果。

方法

回顾性研究陆军特色医学中心2016年10月至2023年6月行机器人辅助MIDCAB开展的情况及治疗效果。收集并分析患者的基线临床资料、MIDCAB相关数据、围术期情况和随访情况。

结果

本研究共纳入23例患者，其中男性21例，女性2例，年龄为（58.17±7.49）岁，体质指数（BMI）为（23.99±3.25）kg/m

，所有患者均有心绞痛症状，其中1例有心肌梗死病史，1例有扩张型心肌病，2例有慢性阻塞性肺疾病（chronic obstructive pulmonary disease， COPD），10例有经皮冠状动脉介入治疗（percutaneous coronary intervention， PCI）史。所有患者均接受机器人辅助MIDCAB，手术均顺利完成，无乳内动脉损伤及术式的转变，乳内动脉和前降支吻合后桥血流良好。左胸切口长度为8（8，8）cm，手术时间为380（300，465）min，术中出血量为300（100，400）mL，ICU时间为3（2，3）d，胸腔引流量为780（525，1 040）mL，术后出院时间为（11.17±2.38）d，未发生住院期间及30 d内死亡率，其中1例患者在30 d内因心包积液再次入院，予以心包穿刺引流等对症处理后好转出院。所有患者门诊及电话随访期间未出现死亡、主要不良心脑血管事件（MACCE）及再次血运重建的情况。

结论

机器人辅助下乳内动脉游离技术精细、安全，微创小切口不停跳下冠状动脉旁路移植术效果安全、可行，近中期结果满意，适于在冠心病微创外科领域推广应用。

Abstract

Objective‍　‍To summarize the clinical efficacy of robotic-assisted left thoracic small-incision minimally invasive direct coronary artery bypass grafting （MIDCAB）. Methods‍　‍A retrospective analysis was conducted on the procedures and treatment outcomes of robotic-assisted MIDCAB in the Army Medical Center of PLA from October 2016 to June 2023. Baseline clinical information， MIDCAB-related data， perioperative conditions and data during follow-up were collected and analyzed. Results‍　‍There were 23 patients subjected， including 21 males and 2 females， with a mean age of 58.17±7.49 years， and a body mass index （BMI） of 23.99±3.25 kg/m

. All of them experienced angina pectoris， and 1 had a history of myocardial infarction， 1 had dilated cardiomyopathy， 2 patients had chronic obstructive pulmonary disease （COPD）， and 10 had a history of percutaneous coronary intervention （PCI）. Robotic-assisted MIDCAB procedure was successfully completed. No internal mammary artery injury or transformation of the procedure occurred in these cases， and excellent bridging vessel flow was achieved after anastomosis of the internal

mammary artery to left anterior descending branch. The incision length in the left chest was 8 （8， 8） cm， the operation time was 380 （300， 465） min， the intraoperative bleeding volume was 300 （100， 400） mL， the length of ICU stay was 3 （2， 3） d， the amount of thoracic drainage was 780 （525， 1 040） mL， and the postoperative length from surgery to discharge was 11.17±2.38 d. No mortality was observed during or within 30 d of hospitalization， and 1 patient was readmitted due to pericardial effusion within 30 d， and was discharged after symptomatic treatment including pericardiocentesis and drainage. No deaths， major adverse cardiovascular and cerebrovascular events （MACCE）， or re-revascularization occurred in all patients during outpatient and telephone follow-up. Conclusion‍　‍Robotic-assisted internal mammary artery dissection is a delicate and safe technique， and coronary artery bypass grafting in minimally invasive small-incision off-pump is effective， safe and feasible， with satisfactory short- and mid-term outcomes. The technique is suitable for minimally invasive coronary artery disease surgery and is worthy of popularization and application.

关键词

冠心病微创冠状动脉旁路移植术机器人辅助乳内动脉获取

Keywords

coronary heart diseaseminimally invasive coronary artery bypass graftingrobot-assistanceinternal mammary artery obtain

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