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 ).