Minimally invasive direct coronary artery bypass plus coronary stent for acute coronarysyndrome: a case report

A 69-year old female patient was admitted because of 3 days of worsened chest pain. Coronary angiography showed 60% stenosis of distal left main stem, chronic total occlusion of left anterior descending (LAD), 70% stenosis at the ostium of a small left circumflex, 70-90% stenosis at the paroxysmal and middle part of a dominant right coronary artery (RCA), and a normal left internal mammary artery (LIMA) with normal origination and orientation. Percutaneous intervention was attempted but failed on the occluded lesion of LAD. The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davinci robot. Eleven days later, the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously. Then the patient was discharged uneventfully after 3 days hospitalization. Our experience suggests that two stop shops of hybrid technique be feasible and safe in the treatment of elderly patient with multiple coronary diseases.