Hybrid robotic coronary artery bypass grafting: how do we do it.

We present the case of a 58-year-old Jehovah’s Witness admitted to our Institution with unstable angina for the previous two weeks. Past medical history included hypertension, hyperlipidemia and previous testicular cancer treated with resection and chemotherapy about 15 years earlier. At admission, a trans-esophageal echocardiogram (TEE) showed preserved ejection fraction (EF) with no regional wall abnormalities or valve disease. A left heart catheterization showed two-vessel disease, including a calcified ostial left anterior descending artery (LAD) lesion and a focal right coronary artery lesion. After discussion with the patient, primary physician and interventional cardiologist, informed consent was obtained for a hybrid revascularization, including robotic coronary artery bypass grafting (CABG) with left internal mammary artery (LIMA) to LAD followed by a percutaneous coronary intervention (PCI) on the right coronary lesion with a drug eluting stent (DES).