Robotic Coronary Artery Bypass Procedures

Robotic Surgery for Coronary Artery Disease

Coronary artery bypass grafting is a surgical treatment for patients in whom one or more coronary arteries—the blood vessels that supply blood to the heart—have become blocked. In this procedure, a new blood vessel is grafted into place that bypasses the clogged artery, ensuring sufficient blood flow to the cardiac muscle.

Over the past decade and a half, surgeons have made great strides in developing minimally-invasive approaches to this surgical treatment-including, in recent years, robotic-assisted procedures. Dr. Didier Loulmet, director of cardiac robotics at NYU Langone Medical Center, has helped pioneer these advances. Robotic coronary artery bypass grafting offers a number of advantages. During traditional open-heart surgery, the heart is reached by cutting open the chest and dividing the breast bone. This median sternotomy approach requires a 10- to 12-inch incision through the sternal bone. In the robotic procedure, the surgeon operates through several much smaller incisions between the ribs. Major incisions are avoided and the sternum doesn't need to be cut, dramatically reducing the traumatic impact of the operation. As a result, patients have less blood loss during the procedure, recover more quickly, experience less pain, and suffer fewer complications. In addition, the da Vinci Si surgical robot's 3-D, high definition camera provides superior visualization of the operating field, which increases the precision of the technique compared to conventional surgery.

There are two main techniques used in robot-assisted coronary bypass surgery:

  • MIDCAB (minimally-invasive direct coronary artery bypass grafting), in which the mammary artery graft is dissected inside the chest through three pencil-sized incisions, followed by the suturing of the mammary artery graft to the heart vessel through a two-inch incision made between the ribs in the left chest.In procedures where only the main coronary artery of the heart (the left anterior descending, or LAD artery) is being bypassed, this operation can often be done without placing the patient on a heart-lung machine—an approach known as an “off-pump” MIDCAB procedure.
  • TECAB (totally endoscopic coronary artery bypass grafting), in which the entire procedure is done through the three ports themselves—requiring no additional incisions.

The surgeon will determine if you are a good candidate for one of these procedures depending on your body habitus and the location of the heart vessel that needs to be bypassed.

Hybrid Robotic Coronary Artery Bypass/Angioplasty Procedure

NYU Langone’s robotic cardiac surgeons are also joining forces with the Medical Center’s interventional cardiologists to offer another cutting-edge procedure that combines a minimally-invasive robotic bypass operation on the heart’s largest coronary artery, the left anterior descending (LAD) artery, with non-invasive angioplasty and stenting of one or more other coronary arteries.

This “hybrid” procedure is performed when a patient requires angioplasty for some blocked coronary arteries, but also has an LAD artery which has become so occluded that opening it with angioplasty is no longer possible. The procedure is typically done in two stages. The robotic bypass surgery, in which the patient’s mammary artery is grafted onto the LAD artery, is done first. This procedure has an extremely high success rate, with 97% of such grafts remaining open 10 years later. The patient then undergoes a non-invasive angioplasty procedure on the other blocked coronary arteries several days later. Since the coronary artery bypass segment is done through several small incisions between the ribs—avoiding the need to cut through the chest bone—and doesn’t require the patient to be placed on a heart-lung machine, the patient can usually be discharged from the hospital the same day that the angioplasty procedure is performed.

Hybrid procedures are rapidly gaining in popularity, both because of their highly favorable outcomes, and because they allow complete restoration of blood flow to the patient’s heart without the need for open-heart surgery, enabling a substantially faster recovery with minimal post-operative discomfort and scarring.

Robotic Coronary Artery Bypass at NYU Langone

NYU Langone Medical Center is one of just a few centers in the Northeast to offer robot-assisted coronary artery bypass surgery. Our robotic bypass procedures are performed by Dr. Didier Loulmet, Chief of Cardiac Surgery at NYU Langone and one of the world's leading pioneers in the development of robot-assisted cardiothoracic procedures, and by Dr. Elias Zias, the newest member of our team of robotic cardiac surgeons.

Dr. Loulmet performed the world's first totally endoscopic robotic coronary artery bypass in 1998—an operation that employs several pencil-size incisions between the ribs—as well as the first totally endoscopic robotic pulmonary vein isolation in 2002. He also assisted on the first robotic mitral valve repair procedure in 1998. His robotic surgical practice focuses on endoscopic coronary artery bypass (TECAB and MIDCAB), including hybrid coronary artery bypass/angioplasty procedures, as well as robot-assisted mitral valve repair and cryoablation for atrial fibrillation.

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