Robot-Assisted MIDCAB Using Bilateral Internal Thoracic Artery: A Propensity Score-Matched Study With OPCAB Patients

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Robotic Surgery

Background:

• Robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) is an emerging strategy for coronary revascularization.
• Total arterial grafting, particularly using bilateral internal thoracic artery (BITA), is increasingly favored in coronary surgery.

Purpose of the Study:

• To evaluate total arterial left-sided coronary revascularization using RA-MIDCAB with BITA.
• To compare RA-MIDCAB with BITA against propensity score-matched (PSM) off-pump coronary artery bypass (OPCAB) surgery.

Main Methods:

• Retrospective analysis of isolated OPCAB and RA-MIDCAB surgeries using BITA from January 2015 to October 2022.
• Propensity score matching (PSM) was employed to create comparable cohorts.
• Primary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE) and mortality; secondary outcomes assessed surgical parameters and hospital stay.

Main Results:

• After PSM, 54 patients were analyzed in both RA-MIDCAB and OPCAB groups.
• No significant differences were observed in mortality or MACCE between the groups.
• RA-MIDCAB demonstrated significantly less blood transfusion (16.7% vs 38.9%), fewer ICU admissions (24.1% vs 96.6%), shorter ICU stays, and shorter overall hospital stays (6.78 vs 8.01 days).

Conclusions:

• Robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) with bilateral internal thoracic artery (BITA) grafting is a safe and effective technique for left coronary artery revascularization.
• RA-MIDCAB offers significant advantages including reduced blood transfusion, fewer intensive care unit admissions, and shorter hospital stays compared to off-pump coronary artery bypass (OPCAB).
• Surgical time for RA-MIDCAB BITA harvesting decreased with increasing experience, indicating a manageable learning curve.