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Robotic Totally Endoscopic Reverse Hybrid Coronary Revascularization: Early and Midterm Outcomes.

Yazan N AlJamal1, Sarah Nisivaco2, Riya Bhasin2

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.

Innovations (Philadelphia, Pa.)
|May 13, 2025
PubMed
Summary

Reverse hybrid coronary revascularization (RHCR), combining percutaneous coronary intervention (PCI) and robotic totally endoscopic coronary artery bypass (TECAB), is safe and effective for multivessel coronary artery disease. This approach shows excellent early and midterm outcomes in selected patients.

Keywords:
TECABhybrid coronary revascularizationrobotic cardiac surgeryrobotic coronary

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Minimally Invasive Cardiac Surgery

Background:

  • Multivessel coronary artery disease (CAD) often requires complex revascularization strategies.
  • Reverse hybrid coronary revascularization (RHCR) integrates percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG).
  • Robotic totally endoscopic coronary artery bypass (TECAB) offers a sternal-sparing approach to CABG.

Purpose of the Study:

  • To review the institutional experience with RHCR over a 10-year period.
  • To evaluate outcomes of RHCR using PCI followed by robotic TECAB.
  • To assess the safety and feasibility of this integrated revascularization strategy.

Main Methods:

  • Retrospective review of patients undergoing RHCR (PCI with drug-eluting stents followed by robotic TECAB).
  • Analysis of patient demographics, procedural details, and clinical outcomes.
  • Evaluation of short-term and midterm results, including major adverse cardiac and cerebrovascular events.

Main Results:

  • 60 patients underwent RHCR between July 2013 and August 2024.
  • Mean age was 66.7 years; 74% were male.
  • No conversions, perioperative strokes, or myocardial infarctions occurred. 93% freedom from major adverse cardiac or cerebrovascular events at mean 34-month follow-up.

Conclusions:

  • RHCR is a safe and feasible option for select patients with multivessel CAD.
  • Stenting followed by robotic TECAB, utilizing internal thoracic artery grafts, yields excellent early and midterm outcomes.
  • Further research is recommended to validate these findings.