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Case Reports
. 2024 Mar 22;30(1):12-15.
doi: 10.1016/j.jccase.2024.03.001. eCollection 2024 Jul.

A case of hybrid robotic-assisted coronary artery bypass grafting and valve-in-valve transcatheter aortic valve replacement

Yoshiyuki Yamashita  1 , Serge Sicouri  1 , Roberto Rodriguez  2 , William A Gray  3 , Francis P Sutter  2 , Basel Ramlawi  1   2
Affiliations
Case Reports

A case of hybrid robotic-assisted coronary artery bypass grafting and valve-in-valve transcatheter aortic valve replacement

Yoshiyuki Yamashita et al. J Cardiol Cases. .

Abstract

We report a hybrid procedure of robotic-assisted coronary artery bypass grafting and transcatheter aortic valve-in-valve implantation for left main disease and prosthetic aortic valve stenosis. Robotic-assisted coronary artery bypass grafting using a left internal mammary artery graft was preferred to percutaneous coronary intervention because of the complex anatomy of the coronary lesion and concerns about dual antiplatelet therapy tolerance. This was followed by a valve-in-valve procedure five days later, allowing the patient to be discharged the next day. This innovative, less invasive approach demonstrates the feasibility and potential for early recovery in appropriately selected patients with complex coronary and aortic valve disease.

Learning objective: Hybrid robotic-assisted coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (AVR) is a feasible and less invasive approach for appropriately selected patients with complex coronary and aortic valve disease who are not good candidates for percutaneous coronary intervention or conventional CABG and surgical AVR.

Keywords: Failed bioprosthesis; Off-pump coronary artery bypass grafting; Robotic coronary artery bypass grafting.

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Conflict of interest statement

Basel Ramlawi is a consultant for Medtronic, Boston Scientific, AtriCure, Shockwave, and Corcym. The other authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Transthoracic echocardiography (a) preoperatively, (b) postoperatively, and (c) at 2-year follow-up.
Fig. 2
Fig. 2
Coronary angiography showing (a) a 75 % stenosis (arrow) in the left main coronary artery at the bifurcation with (b) proximal to mid-left anterior descending stenosis (arrow) and high take-off of the first diagonal branch. A bioprosthetic valve is implanted in the aortic valve position.
Fig. 3
Fig. 3
Valve-in-valve procedure. A second valve was required due to migration of the first valve into the ascending aorta.
See this image and copyright information in PMC

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