During his annual physical exam in 2024, John F., a resident of North Carolina, told his primary care provider that he'd experienced chest discomfort while walking uphill. His doctor recommended a CT scan and stress test to check his heart health. Both test results came back abnormal.
John was referred to an interventional cardiologist who diagnosed him with coronary artery disease. After undergoing a heart catheterization, John learned that he'd suffered a heart attack at some point in the past, despite not noticing symptoms at the time.
After his diagnosis, John met with three different local cardiovascular surgeons who all told him the same thing: From the heart catheterization, it was not clear if there was a target suitable enough to warrant open-heart surgery. He was prescribed medication and told to wait until his condition worsened to take further action.
The Path to UPMC Heart and Vascular Institute
John's symptoms improved with the medications, but his functional status continued to be limited. He was motivated to explore additional treatment options — even if that meant traveling out of state.
“I didn’t feel comfortable with the idea of not doing anything but taking medicine and figuring it out when things got worse,” says John.
A close family friend suggested he receive a second opinion from the UPMC Heart and Vascular Institute in Pittsburgh.
The cardiac surgeons at UPMC carefully reviewed John’s case and discussed the potential risks and benefits of surgical intervention. Given John’s symptom profile and overall goals, the team felt it was reasonable to first pursue less-invasive options that could provide symptom relief with lower risk and faster recovery.
John was subsequently referred to Johannes Bonatti, MD, director of robotic cardiac surgery and cardiothoracic surgeon with the Advanced Revascularization Clinic (ARC), at the UPMC Heart and Vascular Institute to further evaluate minimally invasive and robotic surgical approaches.
The Solution
Dr. Bonatti offered to perform a robotic thoracoscopy to confirm that a suitable target for coronary artery bypass existed. If a target was identified, John would then undergo a minimally invasive hybrid procedure to achieve coronary revascularization. The procedure, a robotic totally endoscopic coronary bypass (TECAB), would then be followed by a percutaneous coronary intervention (PCI).
Living several states away provided some challenges, but John was able to coordinate with the UPMC team virtually before traveling to Pittsburgh for the procedure.
“If I called or sent a message, someone always got back to me quickly,” says John. “They were very responsive and even helped facilitate all necessary tests with my physician at home.”
John and his wife traveled to Pittsburgh in August 2025. On Aug. 4, John underwent a successful a robotic TECAB procedure led by Dr. Bonatti. Two days later, it was followed by a successful PCI, led by cardiologist Catalin Toma, MD.
Dr. Bonatti is an internationally recognized expert in robotic-assisted mitral valve and coronary artery surgery and was the first physician worldwide to perform a robotic endoscopic quadruple coronary bypass surgery. Robotically assisted, minimally invasive cardiac surgery provides comparable results to open heart surgery with higher surgical precision, less chest-wall trauma, fewer restrictions, and quicker recovery.
The Road to Recovery
John stayed in Pittsburgh for a week after surgery to follow up with Dr. Bonatti. After he was cleared, John and his wife drove back to their home in North Carolina.
“For me, the objective of exploring other options was to not have to worry about how I lived my life,” says John.
Now 62, John is back to his regular exercise routine and hobbies, including kayak fishing, golf, skiing, and spending time with his children and grandchildren.
“I’m grateful I was able to make an informed decision with the help of the UPMC team,” says John. “At the end of the day, I never had a feeling other than that my care was first and foremost.”
John’s treatment and results may not be representative of all similar cases.
