Our Summary

This research paper is about a new surgical technique for treating disease in the right coronary artery (RCA), which is a blood vessel in the heart. The technique is called robotic beating-heart totally endoscopic coronary artery bypass (TECAB) and is performed through the right side of the chest.

Traditionally, the left coronary vessels are the usual targets in TECAB because it’s more difficult to reach the RCA due to its location and other technical challenges.

The study looked at patients who underwent this new procedure between July 2013 and April 2019. The patients selected for this procedure had RCA disease that couldn’t be treated with a less invasive procedure (percutaneous intervention) or had an unusual origin of the RCA.

The researchers found that the procedure was completed successfully in all 16 patients (most of whom were male, with an average age of about 61) without needing to switch to a more invasive operation. Only one patient needed additional support (cardiopulmonary bypass) to expose a branch of the RCA. On average, the procedure took about four hours, and half of the patients were able to have their breathing tubes removed right in the operating room. The patients typically stayed in the hospital for a little over two days after the surgery.

No patients died during the follow-up period, which averaged about 21 months. However, one patient needed another operation on the RCA because their original disease got worse about 44 months after the surgery.

The researchers concluded that this new robotic technique for treating RCA disease is a viable option for selected patients. It can even be used for harder-to-reach areas of the RCA.

FAQs

  1. What is the Totally Endoscopic Coronary Artery Bypass (TECAB) procedure?
  2. Who are the ideal candidates for the robotic beating-heart TECAB procedure?
  3. What were the results and conclusions from the study conducted from July 2013 to April 2019 on robotic beating-heart TECAB?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about heart bypass surgery is to follow post-operative instructions carefully, including taking prescribed medications, attending follow-up appointments, and making lifestyle changes such as maintaining a healthy diet and exercising regularly. It is important for patients to listen to their body and report any concerning symptoms to their healthcare provider promptly.

Suitable For

Patients who are typically recommended for heart bypass surgery include those with severe coronary artery disease that cannot be effectively treated with medication or other less invasive procedures, such as angioplasty. Specific indications for heart bypass surgery may include:

  1. Severe blockages in multiple coronary arteries
  2. Severe blockages in the left main coronary artery
  3. Inability to perform percutaneous intervention due to anatomical factors
  4. Anomalous origin of the coronary arteries
  5. Recurrent angina or chest pain despite medical therapy
  6. Previous heart attacks or other cardiac events

Individual patient characteristics, such as age, overall health, and comorbidities, will also be taken into consideration when determining the appropriateness of heart bypass surgery.

Timeline

  • Before the heart bypass surgery, the patient would have undergone diagnostic tests such as angiography to determine the extent of blockage in the coronary arteries.
  • The patient would have been assessed by a cardiac surgeon and anesthetist to determine their suitability for surgery.
  • On the day of the surgery, the patient would have been prepared for the procedure, including receiving anesthesia and being prepped for surgery.
  • During the surgery, the robotic beating-heart TECAB procedure would have been performed, with the right internal mammary artery being used to bypass the right coronary artery.
  • The procedure would have taken approximately 223 minutes to complete, with cardiopulmonary bypass being required in one patient.
  • After the surgery, the patient would have been monitored in the recovery room and then transferred to a hospital room for further observation.
  • The patient would have been discharged from the hospital after an average stay of 2.3 days.
  • Follow-up appointments would have been scheduled to monitor the patient’s progress and ensure the success of the bypass surgery.
  • At a mean follow-up time of 20.6 months, no mortality was observed, although one patient required repeat RCA revascularization for progression of native disease.

What to Ask Your Doctor

  1. What are the benefits of robotic beating-heart TECAB for bypassing the right coronary artery compared to traditional techniques?
  2. What are the potential risks and complications associated with this procedure?
  3. How long is the recovery time after undergoing robotic beating-heart TECAB to the right coronary artery?
  4. Will I need to take any medications or make lifestyle changes after the surgery to maintain the health of the bypassed artery?
  5. How often will I need to follow up with you after the surgery to monitor the success of the bypass and my overall heart health?
  6. Are there any restrictions on physical activity or dietary habits that I should be aware of post-surgery?
  7. What is the long-term outlook for patients who undergo robotic beating-heart TECAB to the right coronary artery?
  8. Are there any alternative treatment options for my condition that I should consider before proceeding with this surgery?

Reference

Authors: Balkhy HH, Kitahara H, Mitzman B, Nisivaco S. Journal: Eur J Cardiothorac Surg. 2020 Mar 1;57(3):529-534. doi: 10.1093/ejcts/ezz283. PMID: 31638696