Robot-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting for Cardiac Allograft Vasculopathy After Heart Transplantation.

BACKGROUND

Cardiac allograft vasculopathy is a major cause of late graft failure and mortality after heart transplantation. Revascularization is often limited by the diffuse nature of the disease, whereas redo sternotomy carries substantial risks in immunosuppressed patients.

CASE SUMMARY: A 66-year-old male developed progressive cardiac allograft vasculopathy with a hemodynamically significant left anterior descending artery stenosis unsuitable for percutaneous coronary intervention, 11 years after heart transplantation. He underwent successful robot-assisted minimally invasive direct coronary artery bypass grafting, with robotic left internal thoracic artery harvesting and an off-pump hand-sewn left internal thoracic artery to left anterior descending artery anastomosis through a left anterior thoracotomy. The postoperative course was uneventful.

DISCUSSION AND TAKE-HOME MESSAGE: This case supports the feasibility of robot-assisted minimally invasive coronary artery bypass grafting as a sternotomy-sparing revascularization strategy in carefully selected heart-transplant recipients with coronary allograft vasculopathy unsuitable for percutaneous treatment.