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Published on: December 11, 2017
Hybrid robotic-assisted coronary revascularization and transcatheter aortic valve replacement: a single-center
Yoshiyuki Yamashita1, Serge Sicouri1, Gianluca Torregrossa2
1Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.
Insights
This study explored a hybrid approach combining robotic-assisted coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR) for complex heart conditions. The hybrid procedure showed promising mid-term outcomes with early recovery in selected patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Interventional Cardiology
Background:
- Hybrid approaches for combined coronary and aortic valve disease are not well-documented.
- Robotic-assisted coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR) offer less invasive options.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a hybrid strategy combining robotic-assisted CABG and TAVR.
- To assess the feasibility and safety of this combined approach for complex coronary and aortic valve disease.
Main Methods:
- A retrospective review of 10 patients (mean age 81) undergoing hybrid CABG and TAVR between January 2018 and June 2022.
- Robotic-assisted CABG (left internal mammary artery to LAD) preceded TAVR, with options for hybrid percutaneous coronary intervention (PCI).
Main Results:
- All patients tolerated robotic-assisted CABG well, with rapid recovery (9 extubated in OR, all ambulatory POD 1).
- One-year mortality was 0%; 3 late deaths occurred between 24-43 months.
- The hybrid approach facilitated staged TAVR from 3 days to 5 months post-CABG.
Conclusions:
- The hybrid robotic-assisted CABG and TAVR approach is feasible for selected patients with complex coronary and aortic valve disease.
- This less invasive strategy shows potential for early recovery and promising mid-term results.
Objectives:
The efficacy of hybrid robotic-assisted coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR) for coronary and aortic valve disease is poorly reported. Herein, we report our experience with this hybrid approach.
Methods:
Between January 2018 and June 2022, 10 (7 male, 3 female) patients with a mean age of 81 years underwent the hybrid procedure. Coronary revascularization was performed prior to TAVR with robotic-assisted left internal mammary artery-to-left anterior descending (LAD) bypass grafting for left main or proximal LAD lesions with or without multivessel disease with or without hybrid percutaneous coronary intervention (PCI).
Results:
Five patients had left main disease, and 5 had proximal LAD disease with or without multivessel disease. All patients tolerated the robotic-assisted CABG procedure well; 9 patients were extubated in the operating room and all patients were ambulatory on postoperative day 1. Five patients underwent hybrid PCI for non-LAD lesions. TAVR was subsequently performed at intervals ranging from 3 days to 5 months after CABG. One patient with end-stage renal disease on hemodialysis required hospitalization for heart failure during the interval period. The 1-year mortality rate was 0%, and 3 patients died during late follow-up (24-43 months).
Conclusions:
This innovative, less invasive approach demonstrates the potential for early recovery in appropriately selected patients with complex coronary and aortic valve disease with promising mid-term outcomes.
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