Comparative long-term effectiveness of robotic vs. non-robotic coronary artery bypass grafting: insights from a...

Robotic coronary artery bypass grafting (CABG) has been increasingly adopted as a minimally invasive option to full sternotomy CABG, but evidence on its long-term effectiveness remains limited. By utilizing the TriNetX Platform, we conducted a retrospective study, including adult patients undergoing CABG between January 1, 2005, and January 1, 2025, excluding those with prior CABG, valve surgery, or cerebrovascular accident. Propensity score matching (1:1) was applied to balance demographics and comorbidities, and outcomes included 30-day mortality, overall survival, cerebrovascular accident (CVA), and repeat revascularization, assessed with Kaplan-Meier and Cox proportional hazards models. A total of 1,796 robotic CABG and 249,580 non-robotic CABG patients were identified, yielding 1,769 matched pairs. Thirty-day mortality was comparable (1.28% vs. 1.78%, p = 0.277). Overall survival revealed no significant difference (p = 0.358; HR = 1.084, 95% CI: 0.912-1.289). Robotic CABG was associated with a lower risk of CVA (p = 0.042; HR = 0.771, 95% CI: 0.600-0.991) but a higher risk of repeat revascularization (p < 0.001; HR = 1.856, 95% CI: 1.448-2.379). In conclusion, this multi-institutional propensity-matched analysis demonstrated that robotic CABG achieved survival comparable to non-robotic CABG, with reduced cerebrovascular risk but increased revascularization, supporting robotic CABG as a safe and effective method and highlighting the potential of hybrid coronary revascularization to integrate surgical and percutaneous benefits in multivessel disease.