Surgical and Interventional Details
Our technique for robotic-assisted LIMA to LAD bypass, constituting the
MIDCAB component of HCR, has been described previously (13, 14).
Briefly, the da Vinci Intuitive robot system (Intuitive Surgical Inc,
Sunnyvale, CA, USA) was utilized for LIMA harvest. The LIMA to LAD
anastomosis was completed ‘off-pump’, through an anterior,
muscle-sparing, non-rib spreading, mini-thoracotomy, facilitated by a
low-profile compression myocardial stabilizer. An intra-coronary shunt
was used in all cases. Graft flow characteristics were assessed in the
operating room using the Medistim VeriQ transit-time flow measurement
system (Medistim USA Inc, Plymouth, MN, USA).
The PCI components of the HCR cases, as well as the interventions in
those patients treated by PCI alone, were performed using standard
techniques (~50% radial approach). All patients
received either second or third generation drug-eluting stents (DES). We
did not deny HCR to those patients that required ‘complex PCI’ (as
defined by the NCDR (National Cardiovascular Data Registry) CathPCI
Registry:
https://www.ncdr.com/WebNCDR/docs/default-source/public-data-collection-documents/cathpci_v4_codersdictionary_4-4.pdf?sfvrsn=2).
All patients were maintained on dual antiplatelet therapy for at least
one year after stent placement. The majority of our sternotomy CABG
cases were completed ‘off-pump’, our technique for which has been
previously reported (15). All patients received a LIMA graft to the LAD.