Robot-assisted vs. conventional MIDCAB: A propensity-matched analysis

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Conventional minimally invasive direct coronary artery bypass grafting (MIDCAB) and robotic assistance (RA-MIDCAB) offer distinct surgical approaches.
• A direct comparison of these techniques, particularly regarding patient outcomes, is lacking in current literature.

Purpose of the Study:

• To compare the clinical outcomes of conventional MIDCAB versus RA-MIDCAB.
• To evaluate the efficacy and safety of robotic assistance in internal thoracic artery harvesting for MIDCAB procedures.

Main Methods:

• Retrospective analysis of consecutive patients undergoing conventional MIDCAB (2005-2021) and RA-MIDCAB (2018-2021).
• Propensity-score matching (PSM) using 27 preoperative covariates to create comparable patient groups.
• Comparison of postoperative outcomes including blood loss, ventilation time, hospital stay, and perioperative complications.

Main Results:

• One hundred and thirty matched pairs were analyzed after PSM, confirming the elimination of preoperative differences.
• RA-MIDCAB patients experienced significantly lower 24-hour postoperative blood loss (300 vs. 450 ml, p=0.002).
• Shorter artificial ventilation time (6 vs. 7 hours, p=0.018) and hospital stay (6 vs. 8 days, p<0.001) were observed in the RA-MIDCAB group.
• No significant differences were found in perioperative complications, short-term, or mid-term mortality between the groups.

Conclusions:

• Robotic assistance in MIDCAB (RA-MIDCAB) presents a viable alternative to conventional MIDCAB.
• RA-MIDCAB is associated with reduced postoperative blood loss and potentially accelerated patient rehabilitation.
• The safety profile, in terms of mortality and perioperative complications, is comparable between RA-MIDCAB and conventional MIDCAB.