Abstract: To assess the short-term outcomes of staged hybrid coronary revascularization performed using robotic-assisted
off-pump coronary bypass grafting followed by percutaneous coronary intervention (PCI) in a non-left anterior descending
(LAD) coronary artery lesion. Methods From January, 2007 to May, 2013, 35 patients (32 male and 3 female patients, mean age
56.7 ± 9.6 years) underwent staged hybrid coronary revascularization. Ten patients had double-vessel and 25 patients had
triple-vessel coronary diseases, and the lesions involved an average of 2.7 ± 0.5 coronary vessels. Coronary artery bypass
grafting was completed in robotic-assisted left internal thoracic artery (ITA) harvesting and LITA to LAD bypass. Coronary
angiography or 64-MSCT was performed to evaluate the patency of the ITA and stents at 6 months and at 1 to 5 years
postoperatively. The patients were followed for major adverse cardiac events (MACE) including cardiac death, acute
myocardial infarction and target lesion revascularization. Results Staged hybrid revascularization was completed successfully
in all the patients without complications. The LITA to LAD anastomosis was completed in minimally invasive direct coronary
bypass grafting (MIDCAB) or totally robotic coronary bypass grafting on beating heart (TECAB) with the assistance of da Vinci
Surgical System. The mean artery graft flow was 36.0±22.5 ml/min, and the graft had a 100% patency before discharge. A total
of 49 stents were deployed in 35 patients within 2 weeks after robotic coronary bypass grafting, with a mean of 1.34±0.6 stents
per case (1 stent in 23 cases, 2 stents in 11 cases, and 3 stents in 1 case). The patients were followed up for 17.5±11.6 months,
and 1 patient had artery graft occlusion and another had in-stent occlusion at 6 months. All the other 33 patients had patent
LITA-to-LAD anastomosis without angina or MACE. Conclusion Staged hybrid revascularization strategy has acceptable
angiographic patency results for both LITA-LAD grafts and PCI interventions.