Study reports on new hybrid treatment of coronary artery disease combining robotic surgery and agioplasty

Chicago 02 April 2003At the American College of Cardiology (ACC) 52nd Annual Scientific Session, Dr. Kenneth D. Stahl, Cardiac Surgeon, presented results of a study into a new breakthrough in the treatment of multiple vessel coronary artery disease, gathered from several centres, including Cleveland Clinic Weston; Buffalo General; Sacred Heart Hospital in Pensacola, Florida; and Selesia, Poland. In the study, Dr. Stahl and his co-authors, Kenneth R. Fromkin, MD; Andrzej Bochenek, MD; W. Douglas Boyd, MD; Thomas A. Vassiliades, MD; Hratch L. Karamanoukian, MD; and Marek Cisowski, MD demonstrate the excellent outcomes and patient benefits achieved when using a combination of angioplasty and a groundbreaking robotically assisted minimally invasive coronary artery bypass procedure, Endoscopic Atraumatic Coronary Artery Bypass Graft (Endo-ACAB), to treat multi-vessel heart disease.


"The long-term benefits of surgery to graft the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) are well known. It is the gold-standard of heart bypass surgery today. This new hybrid treatment option combines the best of surgical and catheter based therapy (PCI) to treat patients in a minimally invasive manner", stated Dr. Kenneth D. Stahl. "From my experience in practice, I believe this combined treatment will ultimately be available to serve thirty to forty percent of all patients who require treatment for blocked coronary arteries."

Patients in the study received Percutaneous Coronary Intervention (PCI) angioplasty, stent placement to non-LAD vessels, and the Endo-ACAB robotically assisted minimally invasive "off-pump" beating-heart coronary artery bypass procedure. In the study, 150 patients received robotically assisted Left Internal Mammary Artery (LIMA) to Left Anterior Descending (LAD) coronary artery bypass grafts, combined with angioplasty to revascularise non-LAD vessels of the heart.

A total of 317 vessels were treated and all of the patients were successfully and completely revascularised. The hybrid approach yielded excellent symptom relief with outstanding LAD patency rates, and lower than average restenosis rates when compared with PCI alone in the treatment of all vessels.

"Endo-ACAB is an important step forward in our ability to restore blood flow to the heart of a patient crippled by coronary blockages. It connects our very best bypass graft to the largest artery in the heart. This key bypass indisputably provides an unequalled long-term benefit to our patients. Endo-ACAB delivers this huge benefit like a ship built within a glass bottle: a classic, proven bypass graft is constructed through natural spaces in the thoracic skeleton. Like the glass bottle, the skeleton is untouched, and postoperative pain is minimised. We at Emory look forward to offering this procedure to our patients", stated Dr. Robert Guyton, Chief of Cardiothoracic Surgery, the Emory Clinic, Atlanta, Georgia.

Dr. Guyton's staff was recently trained in these techniques by two of the authors, Drs. Vassiliades and Stahl. Computer Motion offers Endo-ACAB training courses at its facilities in Santa Barbara, California, and at centres of excellence in the United States. Computer Motion manufactures and markets Endo-ACAB procedure kits developed to provide surgeons with re-usable and disposable products for use in the surgery.

The robotically assisted surgeries were completed using the AESOP Robotic Endoscope Positioner surgical robotic system, or the ZEUS Surgical System, both manufactured by Computer Motion. AESOP allows surgeons to precisely view the anatomy of the heart with greater than ten times magnification, and a steady visual field free from tremor associated with manually held endoscope techniques. Surgeons are able to control AESOP using simple voice commands to accurately position the endoscope during surgery.

"We believe this study will pave the way for closer co-operation between cardiac surgeons and interventional cardiologists, and it is my hope that this type of combined approach to treating heart disease will undergo exponential growth in the near term. Clearly this procedure deserves continued investigation", stated Dr. Kenneth R. Fromkin, Cardiologist, Cleveland Clinic Florida in Weston.

More than 1,3 million patients each year in the United States receive coronary artery revascularisation treatment, including surgical bypass and interventional cardiology. Heart disease is the leading cause of death in the United States, claiming more lives than the next seven leading causes of death combined. "This study is the first look at what can be accomplished when surgeons and cardiologists work together to bring the best possible treatment options to their patients", commented Dr. Thomas Vassiliades, Sacred Heart Hospital, Pensacola, Florida. "I have performed over 500 Endo-ACAB procedures, and the results for my patients have been extremely positive."

Minimally invasive surgery (MIS) offers patients the benefits of smaller incisions with less associated pain and trauma, as well as faster recovery from the effects of surgery. Patients undergoing MIS procedures are often able to leave the hospital within 48 hours. The Endo-ACAB procedure represents an important advance in surgical treatment of heart disease. Patients are operated on "off-pump", on the beating heart without the use of a heart-lung machine, and are able to return to normal activity within an average of 10 days, as opposed to several weeks or even months after traditional stopped-heart open-chest bypass surgery using a sternotomy incision through the sternum or breastbone.

More news on Computer Motion's suite of robot surgery products is available in this VMW issue's article Surgeons train paediatric interventions using robotic telecollaboration between Hannover and Johannesburg.

Leslie Versweyveld

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