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

Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature

Minimally invasive coronary revascularisation was originally developed in the mid 1990s as minimally invasive direct coronary artery bypass (MIDCAB) grafting is a less invasive approach compared to conventional coronary artery bypass grafting (CABG) to address targets in the left anterior descending coronary artery (LAD). Since then, MIDCAB has evolved with the adoption of a robotic platform and the possibility to perform multivessel bypass procedures. Minimally invasive coronary revascularisation surgery also allows for a combination between the benefits of CABG and percutaneous coronary interventions for non-LAD lesions – a hybrid approach. Hybrid coronary revascularisation results in fewer blood transfusions, shorter hospital stay, decreased ventilation times and patients return to work sooner when compared to conventional CABG. This article reviews the available literature, describes standard approaches and considers topics, such as limited access procedures, indications and patient selection, diagnostics and imaging, techniques, anastomotic devices, hybrid coronary revascularisation and outcome analysis.

Robotic Cardiac Surgery Part II: Anesthetic Considerations for Robotic Coronary Artery Bypass Grafting

Coronary artery bypass grafting represents one of the most commonly performed cardiac surgeries worldwide. Recently, interest has increased in providing patients with a less invasive approach to cardiac surgery, such as thoracotomy and endoscopic techniques using robotic technology as an alternative to traditional sternotomy. As the population gets older, the need for additional methods to provide care for sick patients will continue to expand. These advancements will further allow physicians to provide cardiac surgical procedures with less pain and faster recovery for patients.

Robotic Coronary Artery Bypass Grafting for Transplant Vasculopathy

A 60-year-old woman developed cardiac allograft vasculopathy 9 years after heart transplantation and was treated with a drug-eluting stent in the left anterior descending coronary artery. Recurrence of in-stent restenosis was treated with another drug-eluting stent. Recurrent in-stent restenosis was again observed and a robotic mid-coronary artery bypass graft operation was successfully performed. Mid-coronary artery bypass graft is a plausible alternative in patients with cardiac allograft vasculopathy and offers the benefit of a left internal thoracic artery to a left anterior descending coronary artery graft with a sternotomy-sparing approach. This case report documents the adoption of this technique in a redo heart transplant patient, creating the potential for a new tool in the treatment of cardiac allograft vasculopathy.