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Robotic-assisted CABG Using BITA In A Frail Octogenarian Patient: A Case Report With Angiographic Follow-up
Marco Gemelli1, Massimo Baudo
2, Marwan Badri
3, Gianluca Torregrossa
3;
1Azienda Ospedale Università Padova, Padova, Italy,
2Lankenau Institute of Medical Research, Wynnewood, PA, USA,
3Lankenau Medical Center, Wynnewood, PA, USA
BACKGROUND: CABG has shown excellent results in terms of revascularization and long-term outcomes but carries increased risks for elderly patients. Minimally invasive CABG and hybrid coronary revascularization (HCR) could represent a safe option for this group of people.
METHODS: We describe a successful case of robotic HCR in an extremely frail elderly patient.
RESULTS: An 80-year-old man with multiple significative comorbidities was diagnosed with severe calcific three-vessel disease involving the left main and a reduced ejection fraction of 45%, while experiencing unstable angina symptoms. He had a BMI of 17 and needed chronic parenteral nutrition due to a short gut syndrome and the STS score showed a high risk of morbidity and mortality. Our Heart Team discussed the case: despite the high surgical risk, the anatomy posed challenges for stenting without compromising the LAD. Performing a conventional sternotomy CABG would have exposed the patient to a very high risk of non-healing sternal wound. The decision was to offer a robotic BITA CABG with right interior thoracic artery (ITA) anastomosed to the left anterior descending (LAD) artery and the left ITA to the obtuse marginal (OM) artery and stent the right coronary artery (RCA). The operation was performed without complication with a DaVinci Xi robot platform. Intra operative transit time flow assessment recorded a flow of 60 mL/min in RITA-LAD and 100 ml/min in LITA-OM1. Patients was weaned from IABP and inotropes by the first post-operative day (POD). On POD 6 he completed the HCR with a drug eluting stent on the mid RCA. During the angiography both the ITAs were injected, and an excellent result was confirmed. After a post-operative echocardiogram which reported an EF of 60%, he was successfully discharged on POD 7. Patient’s symptoms improved substantially; he keeps doing well 3 months after surgery.
CONCLUSIONS: We presented the successful application of hybrid robotic coronary revascularization in an elderly patient with multiple comorbidities and complex coronary artery disease. By embracing a minimally invasive CABG program, it is possible to treat patients that would not been referred to traditional sternotomy CABG and expand the indications for coronary artery bypass grafting.
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