TECAB Plus PCI Shows Promise: Early Studies


SAN FRANCISCO — A hybrid technique using beating-heart total endoscopic coronary artery bypass and newer stents that are associated with a lower incidence of restenosis has shown promise in early investigations.

Internal thoracic artery grafts plus percutaneous coronary intervention provided a less-invasive means of complete revascularization, compared with standard surgery, according to a study presented at the annual meeting of the Society of Thoracic Surgeons.

A total of 315 beating-heart total endoscopic coronary artery bypass (TECAB) operations were performed from July 2004 until June 2008 by Dr. Sudhir P. Srivastava and colleagues at the University of Chicago. Planned adjunctive PCI was performed in 70 of these patients. A total of 170 internal thoracic artery grafts were performed, and beating-heart TECAB was aided by the daVinci S robotic system and an endowrist stabilizer.

Adjunctive PCI was done before TECAB in 11 patients, simultaneously in 5 patients, and after TECAB in 54 patients. A total of 83 stents (81 drug eluting, 2 bare metal) were placed in 79 coronary arteries. In 57 patients, 92 grafts were studied with conventional angiography, and 15 grafts in 13 patients were studied using CT angiography.

One patient died of unknown causes after being discharged, and a second patient died of aspiration in a nursing home. Only one patient had a cardiovascular adverse event following PCI. No myocardial infarction or reintervention in the PCI target coronary artery occurred. The 92 grafts studied using conventional angiography showed FitzGibbon A, B, and O scores of 90, 1, and 1, respectively.

All 68 surviving patients have remained free of major adverse cardiac events; thus, the procedure resulted in 100% clinical freedom from target revascularization failure, according to Dr. Srivastava.

“Today, robotic cardiac surgery has evolved to a point where less-invasive techniques could be offered to patients to achieve comparable, if not superior, results with faster functional recovery.

“Hybrid coronary revascularization with beating-heart TECAB offers an option of complete revascularization in complex multivessel coronary artery disease with use of [internal thoracic artery] grafts that have proven superior long-term results and newer stents. Angiography of bypass grafts during planned PCI allows for qualitative graft patency assessment.

“The collaborative efforts between cardiac surgeons and cardiologists in hybrid operating suites may become the future of less-invasive options to treat coronary artery disease,” Dr. Srivastava said in an interview.

Dr. Srivastava, who now practices in Atlanta, disclosed that he is a consultant to Intuitive Surgical Inc., Medtronic Inc., and Cardica, and that he is on the advisory board of Medical CV Inc.

Robotic cardiac surgery has evolved to allow for less-invasive techniques that can achieve comparable, if not superior, results, says Dr. Sudhir P. Srivastava. DAN DRY/UNIVERSITY OF CHICAGO MAGAZINE

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