Case Report
This case report highlights the feasibility of treating a patient with a
full robotically hybrid revascularization strategy. We report, a case of
fully Robotically-Assisted HCR. RE-MIDCAB surgery, combined with R-PCI.
A 62-year-old man presents with a two years history of typical stable
angina on exertion.
The patient has a history of arterial hypertension, hyperlipidemia,
obesity (BMI 31kg/m2), insulin-dependent diabetes
mellitus (hemoglobin A1c of 8.4%), and previous smoking
until 2012.
Physical examination was normal. Resting echocardiography showed a
preserved left ventricular ejection fraction (biplane 60%) without wall
motion abnormalities. A cycle ergometer stress test was submaximal and
hence inconclusive to rule out CAD.
Invasive Coronary Angiography (ICA) revealed a severe three-vessel
disease. Multiple atherosclerotic lesions were present with an 80%
focal stenosis in the middle RCA (Fig.2A) , a 70-80% focal
stenosis in the proximal LCx (Fig.2B) , and diffuse and
extensive lesions of the LAD (Fig.2C) . The anatomical SYNTAX
Score was 15.
A hemodynamic evaluation of the lesions was performed using a Fractional
Flow Reserve (FFR) with a pullback maneuver, in this way it is possible
to evaluate the distribution of epicardial resistance to determine CAD
pattern (focal or diffuse CAD)2. The hyperemic
Pullback Pressure Gradient (PPG), was used to quantify the CAD
pattern3. The FFR measurement in the LAD showed an FFR
value of 0.75 with a PPG value of 0.40(Fig.2D ).