eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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3/2022
vol. 19
 
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abstract:
Letter to the Editor

Bilateral internal mammary artery in coronary artery bypass grafting using the latest da Vinci Xi robot

Radosław Smoczyński
1
,
Jakub Staromłyński
1
,
Maciej Bartczak
1
,
Mariusz Kowalewski
1
,
Tomasz Pawłowski
2
,
Robert Gil
2
,
Dominik Drobiński
1
,
Zbigniew Król
1
,
Waldemar Wierzba
1
,
Piotr Suwalski
1

  1. Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
  2. Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
Kardiochirurgia i Torakochirurgia Polska 2022; 19 (3): 158-160
DOI: https://doi.org/10.5114/kitp.2022.119766
Online publish date: 2022/10/06
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Coronary artery bypass grafting using the right and left internal mammary artery (BIMA) is currently the most durable surgical treatment for coronary artery disease [1]. This is due to the use of arterial (rather than venous) material, which has the proven advantage of durability. In addition, avoiding central aortic anastomosis by direct subclavian artery blood supply through the left (LIMA) and right (RIMA) internal mammary arteries, thus aorta manipulation, is associated with lower risk of stroke [2]. Another advantage is no additional wound for graft harvesting (as for the radial artery). Harvesting both internal mammary arteries usually requires access via sternotomy, which is associated with a higher risk of worse wound healing, increased postoperative pain, and longer rehabilitation [3]. The use of the da Vinci robot for coronary artery bypass grafting is a valid and elegant alternative to surgery via sternotomy as it combines the advantages of arterial revascularization using BIMA without opening the sternum [4]. In this letter to the editor, we present the first Polish experience of coronary revascularization using the da Vinci robot based on treatment of significant stenosis in the distal segment of the left main coronary artery.
A 66-year-old patient with coronary artery disease, hypertension and gout was admitted to the Department of Cardiac Surgery of the Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education in Warsaw for surgical treatment. The patient had recently reported stenocardial symptoms on slight exertion (CCS class II). Coronary angiography revealed a significant lesion in the distal segment of the left coronary artery. Resting echocardiography showed no segmental wall motion abnormalities with ejection fraction estimated at 60% and no significant valvular lesions. The patient was qualified by the local Heart Team for surgical coronary revascularization using the da Vinci robot.
The operation was performed on March 15, 2021. The patient was placed on his back with a small roll under the left scapula. A double-lumen tube was used for intubation and the left lung was deflated. Skin ports for the three robotic arms were placed in the 2nd, 4th and 6th intercostal space on the left side of the chest. The port in the 4th intercostal was used to introduce the endoscope, while the ports in the 2nd and 6th intercostal were used to introduce the robotic tools for...


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