Hybrid Coronary Revascularization by Endoscopic Robotic Coronary Artery Bypass Grafting on Beating Heart and Stent Placement

Background. Hybrid revascularization has been used in minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for multivessel coronary artery disease (CAD). Very few endoscopic robotic coronary bypasses on the beating heart have been reported. The aim of this study was to assess hybrid revascularization by endoscopic robotic coronary artery bypass on the beating heart with percutaneous coronary intervention in a staged approach. Methods. Forty-two patients underwent selective robotic coronary artery bypass grafting on the beating heart. Ten patients with right coronary artery or circumflex coronary stenosis underwent stent placement after robotic left internal mammary artery (LIMA) anastomosis to the left anterior descending (LAD) artery surgery in a separate session. The average age of the patients was 62.3 +/- 12.1 years old. Coronary arteriography showed significant stenosis or total occlusion of the LAD in all patients and significant stenosis in the right coronary or circumflex arteries. The LIMA was harvested by the da Vinci S robotic surgical system (Intuitive Surgical, Sunnyvale, CA) and manually anastomosed to the LAD off-pump in 6 patients, and by totally endoscopic bypass on the beating heart in 4 patients. Percutaneous coronary intervention with placement of a stent to stenotic nonLAD targets was performed 4 to 5 days after operation. All LIMA-LAD grafts were assessed angiographically. Results. All 10 patients had off-pump robotic bypass surgery and stent placement using a staged approach without complications. Conclusions. Our preliminary study shows that hybrid coronary revascularization by endoscopic robotic coronary artery bypass grafting on a beating heart and subsequent stent placement is a feasible integrated approach for patients with multivessel CAD.