Simultaneous Robotic Off-Pump Coronary Artery Bypass and Orthotopic Liver Transplantation in a Child-Pugh C Patient: An Operative Playbook.

A 69-year-old male individual with Child-Pugh class C alcoholic cirrhosis and 2-vessel coronary artery disease underwent combined robotic off-pump minimally invasive direct coronary artery bypass (MIDCAB) and simultaneous orthotopic liver transplant. The patient tolerated the procedure without complications, was extubated on postoperative day 1, and discharged home on day 9. At 15 months postprocedure he had preserved graft function, stable liver tests, and no major adverse cardiac events. This novel procedure of combined robotic minimally invasive direct coronary artery bypass and orthotopic liver transplant may offer a promising alternative for high-risk patients with end-stage liver disease and coronary artery disease.