Robotic Hybrid Total Arterial Coronary Revascularization: Techniques, Pathways, and Outcomes

Robotic hybrid total arterial coronary revascularization sits at the intersection of three major trends in contemporary coronary care: (i) the pursuit of durable, long-term outcomes associated with arterial grafting, (ii) the maturation of minimally invasive and robotic-assisted coronary surgery, and (iii) the evolution of hybrid coronary revascularization strategies that combine surgical and percutaneous modalities within a Heart Team framework. While conventional CABG remains a cornerstone for multivessel coronary artery disease, interest is increasing in approaches that may reduce surgical trauma and accelerate recovery without compromising the durability of revascularization.This Research Topic aims to provide a dedicated forum to examine current evidence, technical approaches, and clinical pathways for robotic hybrid total arterial revascularization. This includes robotic-assisted internal thoracic artery harvesting, minimally invasive coronary anastomosis techniques, and the integration of PCI for non-surgically treated targets - while seeking to avoid saphenous vein graft use where appropriate. Despite growing adoption in experienced centers, important questions remain regarding patient selection, procedural staging (PCI-first vs surgery-first vs single-session approaches), peri-procedural antiplatelet and anticoagulation management, reproducibility across programs, and how outcomes compare with multi-arterial CABG via sternotomy and contemporary PCI strategies.We encourage contributions in the following areas:• Robotic and minimally invasive surgical coronary revascularization, including robotic-assisted conduit harvesting and minimally invasive approaches to surgical grafting using arterial conduits.• Hybrid coronary revascularization pathways, including strategy design (which vessels are treated surgically vs percutaneously) and staging models (CABG-first, PCI-first, or single-admission approaches).• Total arterial concepts within hybrid practice, including definitions, conduit selection (e.g., internal thoracic artery ± additional arterial grafts), and practical considerations when aiming to avoid saphenous vein grafts.• Patient selection and Heart Team decision-making, including anatomy/lesion complexity, comorbidity and frailty considerations, and criteria used to identify patients most likely to benefit from a robotic hybrid arterial strategy.• Peri-procedural management across surgical and PCI phases, including antiplatelet/antithrombotic strategies, bleeding/ischemic trade-offs, and protocol-driven care pathways.• Imaging, planning, and quality assurance, including pre-procedural planning (e.g., CT-based assessment where relevant), intra-operative graft assessment, and follow-up strategies to evaluate revascularization success.• Clinical outcomes and comparative evidence, including graft performance, repeat revascularization, MACCE, recovery trajectories, patient-reported outcomes, and comparisons with conventional CABG and contemporary PCI strategies.We welcome submissions that clarify definitions and endpoints relevant to this field - such as what “total arterial” means in a hybrid paradigm - and report clinically meaningful outcomes including graft performance, repeat revascularization, ischemic events, symptom improvement, functional recovery, and longer-term follow-up where available. Contributions that evaluate operational and health-system considerations (resource utilization, hybrid suite pathways, multidisciplinary coordination, and patient-reported outcomes) are also encouraged, as these factors often determine whether promising techniques can be adopted safely and consistently beyond early adopter institutions.By bringing together perspectives from cardiac surgery, interventional cardiology, anesthesia, and cardiovascular imaging, this collection aims to clarify current best practice, identify evidence gaps, and outline priorities for registries and future comparative studies Topic editors: Massimo Bonacchi, Kevin Liou Source: https://www.frontiersin.org/research-topics/80493/robotic-hybrid-total-arterial-coronary-revascularization-techniques-pathways-and-outcomes