Propensity-Matched Outcomes of Multivessel Robotic vs Conventional Coronary Artery Grafting

This study contrasts robotic multivessel minimally invasive direct coronary artery bypass grafting (RMIDCAB) with conventional sternotomy coronary artery bypass grafting (CSCABG). It aims to enrich the literature with quality comparisons of these procedures.

Coronary artery bypass grafting operations from 2014 to 2023 were reviewed. Propensity score matching, considering age, sex, The Society of Thoracic Surgeons predicted risk of mortality, and body mass index yielded 338 patients per group. RMIDCAB used a 3-port technique for mammary artery/arteries harvesting and hand suturing through a 6-cm thoracotomy in the left fourth or fifth intercostal space, with cardiopulmonary bypass (CPB) in some cases. CSCABG used a midline sternotomy incision, with or without CPB and cardioplegic arrest.

RMIDCAB demonstrated advantages over CSCABG in reducing postoperative ventilation hours (9.91 vs 15.32, P = .053), fewer intensive care unit hours (51.03 vs 60.39, P = .027), and lower rates of postoperative complications such as prolonged pulmonary ventilation (2.37% vs 8.28.%, P < .001) and atrial fibrillation (18.93% vs 31.66%, P < .001). CSCABG had more grafts per patient (3.04 vs 2.46). Length of stay was significantly shorter in robotic group (5.90 vs 7.24 days, P < .001). The difference in 30-day and hospital mortality was not significant (0.89% vs 1.48% P = .477).

Multivessel RMIDCAB is a safe technique compared with CSCABG. These findings underscore the value of integrating robotic techniques into coronary surgery to improve patient care and outcomes.