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.