First report of a hybrid robotic beating-heart quadruple totally endoscopic coronary artery bypass: toward complete revascularization.

To the best of our knowledge, this is the first report describing robotic beating-heart quadruple all-arterial totally endoscopic coronary artery bypass combined with percutaneous coronary intervention attempting complete revascularization (residual SYNTAX score 0). A 66-year-old male with severe triple-vessel coronary artery disease underwent percutaneous coronary intervention for a sub-total occlusion of the right coronary artery as the initial component of a hybrid revascularization strategy. Subsequently, the left coronary system was revascularized via robotic beating-heart totally endoscopic coronary artery bypass with bilateral internal mammary artery grafts.