Is the myocardial enzyme release in totally endoscopic CABG on the arrested heart tolerable?

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Aims: Robotic totally endoscopic CABG (TECAB) enables coronary artery bypass grafting without sternotomy or thoracotomy. However longer CPB times and aortic endoocclusion times are currently required as compared with standard CABG operations. We investigated if longer operation times affect the myocardial enzyme release and the postoperative course. Methods: From 2001–2006 85 patients, aged 58 (31–76) years, underwent TECAB on the arrested heart using the da Vinci™ telemanipulator and remote access perfusion via the femoral vessels (ESTECH™ or HEARTPORT™). The operations intended were LIMA-LAD or Dg (n=74), RIMA-RCA (n=2), double vessel LIMA-OM/Cx and RIMA-LAD (n=8), and double vessel LIMA-LAD and SVG-RCA (n=1). TECAB duration was 254 (178–710) minutes, cardiopulmonary bypass time was 114 (57–428) minutes, and aortic endoocclusion time 65 (28–230) minutes. Results: The postoperative ventilation time was 8 (0–278) hours, the ICU stay 20 (11–389) hours. The postoperative stay at our department was 6 (4–22) days and we observed no hospital death in this series. 45% of the patients had an increased postoperative peak CKMB level, 75% an increased Troponin T level. Postoperative peak CK-MB levels significantly increased with: TECAB duration (r=0.588, p<0.001), CPB time (r=0.521, p<0.001), aortic endoocclusion time (r=0.400, p<0.001), and translated into moderately prolonged ICUstay (r=0.432, p<0.001), and ventilation time (r=0.517, p<0.001). CK-MB levels were not associated with gender, age, or EuroSCORE. The postoperative left ventricular ejection fraction (LVEF) did not differ significantly from preoperative LVEF. Conclusion: Myocardial protection can well be established in AHTECAB operations. An influence of increased myocardial enzyme release on postoperative ventilation

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