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

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.