The study objective is to compare standard CABG to a hybrid revascularization strategy (RA-MIDCAB + PCI) in patients who have multi-vessel CAD and an indication for surgery, but who have a slightly higher risk of post-operative complications.

Inclusion Criteria:

1. Multi-vessel CAD with an indication for revascularization,

2. Presence of at least 1 risk factor for increased risk of post-operative death or major complication,

   • Any patient Age > 80, OR

   • Any patient with eGFR (Glomerular Filtration Rate) < 50, OR

   • Any patient with LVEF < 40%, OR

   • Any patient deemed to be "frail" by consulting surgeon. OR

   • Patients > 75 years of age with at least one of the following:

     • Ejection fraction < 50%
     • History of prior CVA (Cerebral Vascular Accident)

3. Coronary artery anatomy appropriate for a robotically-assisted MIDCAB or regular CABG, vessels other than the left anterior descending with lesions amenable to either CABG or PCI.

Exclusion criteria

1. Significant left main coronary artery disease,
2. Ejection fraction < 30%,
3. Patients with GFR < 30,
4. Patients unable to take dual anti-platelet agents due to high bleeding risk,
5. Patients requiring emergent surgery, including patients with hemodynamic instability,
6. Patients with anatomy not suitable for a robotically-assisted approach (by CT chest).