Hybrid Myocardial Revascularization or Multivessel Minimally Invasive Direct Coronary Artery Bypass: Two Case Reports

Since the first introduction of direct grafting of the Left Anterior Descending artery (LAD) by Kolessov in 1967, the tendency in myocardial revascularization has been towards less invasive techniques. New developments are increasingly making it possible to extend the indication for Robotically Assisted Minimally Invasive Direct Coronary Artery Bypass (RAMIDCAB) surgery to patients with triple vessel disease. Here, we present two cases in which complete revascularization was successfully achieved. The first patient underwent a hybrid procedure involving RA-MIDCAB followed by Percutaneous Coronary Intervention (PCI); the other patient received RA-MIDCAB in which bilateral internal mammary arteries were used as a conduit for grafting. The implications, limitations and challenges of these interventional strategies are discussed. Furthermore, it is suggested that minimally invasive strategies might have important benefits especially for high-risk patients, and that these strategies should be included in decisionmaking by the Heart Team if available.