Management
Following a discussion in the Heart team, a hybrid robotically-assisted
revascularization was proposed to the patient. First, the RE-MIDCAB
(DaVinci X Surgical System, Intuitive Surgical, Sunnyvale, USA),
robotically-assisted harvesting of a pedicled LIMA followed by an
end-to-side anastomosis to LAD, was performed via a left non-rib
spreading mini-thoracotomy (Video 1) . On the
2nd post-operative day, the staged R-PCI
revascularization was performed. The LIMA-LAD anastomosis was assessed
by coronary angiography before PCI, confirming a good quality of the
bypass (Fig.3A) . Then, R-PCI was performed using the CorPath
GRX Robotic-PCI System (Fig.3B)(Video 2) . A Drug-Eluting Stent
(Abbott Sierra 3.0 x 33 mm) was placed on the RCA (Fig.3C) and
a long Drug-Eluting Stent (Biotronik, Orsiro Mission 3.0 x 40 mm) was
placed from LCx to the first obtuse marginal branch
(OM1)(Fig.3D)(Video 3) , achieving an excellent angiographic
result. The postoperative course was uneventful and the patient was
discharged on the 3rd post-operative day.
A first outpatient contact 6 weeks after the procedure the patient
remains free from angina and without any adverse event.