Urgent Robotic Coronary Revascularization In Morbid Obese Patient
Aleksander Dokollari, MD, PhD1, Serge Sicouri2, Leila Hosseinian1, Basel Ramlawi1, Ozgun Erten2, Francis Sutter1, Gianluca Torregrossa1.
1Lankenau Medical Center, Wynnewood, PA, USA, 2Lankenau Institute for Medical Research, Wynnewood, PA, USA.
BACKGROUND: To understand the importance of minimally invasive robotic-assisted coronary artery bypass grafting (CABG) in morbidly obese patients with coronary artery disease, we describe the case of a 54-year-old male with morbid obesity (BMI=58 kg/m2) and multiple comorbidities presenting chest pain and treated with off-pump hybrid robotic-assisted (HCR) LITA-LAD. METHODS: The patient signed the consent for the release of his medical data. RESULTS: A 54-year-old male with a BMI of 58 kg/m2 (194 kg) presented with acute chest pain. He also reported dyspnea after 50 feet of walking that resolves after 5 minutes of activity cessation. Past medical history was remarkable for morbid obesity (BMI=67 kg/m2), four episodes of pulmonary embolism from deep vein thrombosis of lower extremities, positive family history of cardiac disease and other multiple comorbidities.
Coronary angiography evidenced a culprit lesion of 70% on LAD; 80%-D1; 70%-D2; 60%-OM; 60%-RCA. Due to the high STS risk score (42%) and the morbid obesity, the heart-team opted for off-pump HCR CABG. To prevent ventilation complications during robotic-assisted CABG, two reinforced femoral vein sheaths were introduced bilaterally in case urgent veno-venous extracorporeal membrane oxygenation would have become necessary. The patient underwent robotic-assisted LITA-LAD with a Medistim flow of 157 ml/min, was extubated the following day and was discharged home on day four. Medications at discharge included aspirin 325 mg, Rivaroxaban, ACE-inhibitor, ezetimibe and B-blocker. In the context of HCR, he underwent percutaneous coronary intervention of the PDA and OM at one month after the procedure while the LIMA-LAD anastomosis was perfectly functional. CONCLUSIONS: Robotic-assisted HCR represent a valuable procedure in the delicate but growing population of morbid obese patients.
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