Totally endoscopic coronary artery bypass grafting

Considering the full spectrum of competition for coronary stents, as I have alluded to in prior posts, the principal drawback to coronary artery bypass grafting in its comparison with stents is its inherent invasiveness.  It is for this reason that minimally invasive approaches to coronary artery bypass grafting are being developed.  The "least" invasive of these options is totally endoscopic coronary artery bypass grafting, or TECAB.  Below is an excerpt from "Worldwide Coronary Stents 2008-2017", which describes TECAB.  

Following this is a video on the procedure (note, please, an ORLive.com peformance of TECAB was  scheduled for June 10, 2009.  If ORLive.com makes a video available, we will post it here).


TECAB comprises minimally invasive cardiac surgery performed via port access. A leading developer of TECAB, HeartPort, Inc., was purchased for $81 million in 2001 by Johnson and Johnson and folded into its Ethicon group. In 2006, Ethicon recalled the DFK24 HeartPort direct flow arterial cannula after reports that the distal tip of the arterial cannula could become disconnected from the body of the cannula and fall into the cardiac cavity. The HeartPort coronary sinus catheter has been used since that time for such procedures as cardioplegia and biventricular pacing.

Coronary bypass accomplished with the use of TECAB technology can be a challenge even for skilled and experienced surgeons. In addition, TECAB is not only technically difficult, but its success also depends on whether the anesthesiologist is proficient in transesophageal echocardiogram to guide proper placement of the coronary sinus catheter, pulmonary artery catheter, venous drainage cannula, and endoaortic balloon catheter. TECAB’s proposed advantages (less post-op pain, decreased hospitalization and rehabilitation periods, and reduced health care costs) remain unsubstantiated by properly designed prospective investigational research studies.

Most lethal risks associated with TECAB are not associated with conventional CABG and include aortic dissection, aortic valve trauma, coronary sinus trauma, and right ventricular rupture. Other complications are similar to those of MIDCAB. In addition, TECAB requires proper placement of a double-lumen endotracheal tube with one-lung ventilation. An anterior mediastinotomy and thoracic port in conjunction with a specially designed set of endovascular catheters is also used. These catheters and the use of a modified CPB system provide complete cardiopulmonary support.

 

(Editorial:  While the technology advances necessary to provide a completely endoscopic approach to coronary artery bypass grafting are indeed impressive, one cannot help but wonder if the expense demanded for use of a robotic system will ultimately achieve an outcome at best comparable to drug-eluting stents.)

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