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.