Robotic Coronary Bypass Surgery

Robotic-assisted coronary artery bypass is minimally-invasive and an innovative way to care for patients with coronary artery disease. Coronary artery disease occurs in patients for a variety of reasons and is associated with certain risk factors including smoking, diabetes, advanced age, family history, high cholesterol, hypertension, diet, and others. Patients with coronary artery disease may develop arterial blockages that can lead to chest pain, shortness of breath, heart attacks, and sudden death. For patients with arterial blockages that require intervention, two main treatment options are available: traditional coronary artery bypass surgery (CABG) and percutaneous coronary intervention, or stenting.

Traditional Coronary Bypass Surgery Procedure

Traditional bypass surgery involves an incision in the center of the chest to access the heart and requires a heart-lung machine for grafts to be sewn to arteries that bypass the blocked areas. We typically use an artery off of the chest wall, called the left internal mammary artery, or LIMA to bypass the most important artery on the heart, the left anterior descending or LAD. Then veins from the leg are used to bypass the other arteries on the heart. This form of treatment is one of the most effective treatments for patients with multiple blockages and has been associated with improved long-term survival and very low risks of dying from complications from surgery.

Alternatively, individual patients with blockages can be treated effectively with stents which have continued to improve over the last decade. Stents are often the first line of treatment for patients with single obstructions or blockages that do not involve the LAD. This is done with a catheter introduced through an artery in the leg or wrist.

Often, patients may be eligible for either procedure, and it is prevalent for cardiologists and cardiac surgeons at Emory to discuss which treatment would be the best approach for each patient. Many times, it is clear to both surgeons and cardiologists which treatment is preferred.

Robotic Assisted Bypass Operation

At Emory, a robotic-assisted bypass operation is also an option. The robotic approach has several potential advantages including a shorter time to recovery, a lower risk of stroke, less bleeding risks, and a lower incidence of infection. The procedures do not involve dividing any bones to enter the chest and involve four small incisions in the left chest, three 1 cm incisions to do the robotic part of the procedure, and one 3-4 cm incision to sew the bypass to the LAD. The heart-lung machine is not used, and the heart is not stopped. At Emory, we have performed over 800 robotic-assisted bypass operations with excellent short- and long-term results.

There are two situations in which a robotic bypass may be an option. Patients with only one blockage on the front of the heart (LAD) which is better treated with the LIMA bypass compared to a stent. This depends on the location of the blockage and other factors which may make a stent more difficult or less likely to last a long time. The LIMA bypass is the best bypass because the patency rate (the ability of the bypass graft to stay open for a long time) is higher than 90% at ten years.

The other situation for which a robotic bypass may be an option is for patients with more than one blockage in addition to the blockage on the front of the heart (LAD). In patients with multiple blockages, sometimes a robotic bypass can be performed on the front of the heart and stents can be used to treat blockages in the other areas of the heart. This depends on the complexity of the different blockages and the ability to do a robotic bypass as well as the ability to stent the other blockages. This approach is called hybrid coronary revascularization because we are using the advantages of each procedure to provide a tailored treatment approach for individual patients. This requires a team approach among interventional cardiologists and cardiac surgeons. At Emory, we have one of the most significant robotic bypass and hybrid coronary revascularization programs in the country, and we are committed to taking care of patients and providing the best treatment approach for each patient with coronary artery disease.

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