Robotic-Assisted Aortic Valve Replacement and Coronary Artery Bypass Grafting.

Abstract

Left chest robotic left internal thoracic artery (LITA) to left anterior descending (LAD) coronary revascularization has been established. We describe robotic aortic valve replacement and coronary artery bypass grafting through a right lateral approach. A 73-year-old woman with severe aortic insufficiency, 70% LAD stenosis, and ejection fraction of 0.35 presented with recalcitrant symptoms. She sustained a stroke 1 year before surgery. She was frail, with a body mass index of 17 kg/m². Her Society of Thoracic Surgeons predicted risk of mortality was 10%. Given minimal leaflet calcium, transcatheter options were declined, and she was referred for high-risk nonsternotomy surgical consideration. After informed consent, a single-incision 4-cm right lateral working incision facilitated on-pump arrested fully robotic 23-mm bioprosthetic aortic valve replacement and LITA-LAD grafting. The LITA harvest time was 43 minutes, and LAD anastomosis was 27 minutes. This frail patient recovered expectantly and was discharged home. Robotic aortic valve replacement and coronary artery bypass grafting is feasible and may represent a viable future option for patients with concomitant aortic valve and coronary disease.