Endoscopic multivessel coronary artery bypass grafting using automated device for proximal anastomosis

Background: The use of computer-enhanced telemanipulation robots in cardiothoracic surgery can reduce the need for open surgical access and enable closed-chest, endoscopic procedures, but these procedures have been limited to anterior target vessels. The feasibility of fully endoscopic multivessel, coronary artery bypass grafting (CABG) was examined. Methods: Fully endoscopic, multivessel CABG solely through surgical ports was performed on 23 dogs weighing 75 to 85 pounds. A proximal anastomosis was made with the Symmetry bypass system aortic connector. The aorta was cross clamped, and cardioplegia solution was administered through the vein graft into the ascending aorta. Results: Eighteen of 23 procedures yielded successful proximal anastomoses and 1 to 3 distal anastomoses. Conclusion: Endoscopic anastomosis to the ascending aorta is feasible with the Symmetry bypass connector. Antegrade cardioplegia and aortic root venting can then be easily accomplished. This approach simplifies closed chest cardioplegic arrest for multivessel CABG.