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Conventional hybrid coronary vs. robot-assisted minimally invasive direct revascularization: a meta-analysis and
Carla L Schuering1, Vanessa I T Zwaans1, Anna Huang1
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
Insights
Hybrid coronary revascularization (HCR) combines minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI). Robotic-assisted HCR showed shorter hospital stays and higher drug-eluting stent use compared to conventional methods.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Robotics
Background:
- Coronary artery disease (CAD) management involves revascularization strategies.
- Hybrid coronary revascularization (HCR) integrates minimally invasive direct coronary artery bypass (MIDCAB) with percutaneous coronary intervention (PCI).
- Evaluating robotic assistance in HCR is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the outcomes of robot-assisted HCR versus conventional HCR.
- To analyze patient data from a systematic literature review on HCR approaches.
- To assess the efficacy and safety of robotic assistance in HCR procedures.
Main Methods:
- Systematic literature review and individual patient data analysis.
- Inclusion of studies published up to February 28, 2025, adhering to PRISMA guidelines.
- Analysis of data from 2,048 patients undergoing MIDCAB for LAD lesions and perioperative PCI for non-LAD lesions.
Main Results:
- Robot-assisted HCR group (903 patients) exhibited significantly higher rates of right coronary artery stenosis and drug-eluting stent use.
- Robot-assisted HCR was associated with significantly shorter hospital stays (4.27 days vs. 10.27 days).
- Mortality rates were low and comparable between robotic and conventional HCR groups; wound complications were slightly higher in the robotic group, while pleural effusion, pericardial effusion, and pneumothorax were more frequent in the conventional group.
Conclusions:
- Hybrid coronary revascularization presents a less invasive treatment option for coronary artery disease.
- Robotic assistance in HCR may lead to improved clinical outcomes, including reduced hospital stay.
- Further research is needed to validate these findings due to limited adoption and data heterogeneity.
Objectives:
Hybrid coronary revascularization (HCR), a revascularization strategy that amalgamates the minimally invasive direct coronary artery bypass (MIDCAB) procedure and percutaneous coronary intervention (PCI), represents a significant advancement in coronary artery disease treatment. This study compares conventional and robotic approaches in HCR.
Methods:
A systematic literature review and individual patient data analysis was conducted via PubMed following PRISMA guidelines, including original works published until 28 February 2025.
Results:
32 publications met the inclusion criteria, providing individual data from 2,048 patients. All patients underwent MIDCAB for LAD lesions and perioperative PCI for non-LAD lesions. 903 patients (670 male, 233 female; mean age 51.69 ± 7.77 years; BMI 34.66 ± 13.13) were treated with robot-assisted HCR, whilst 1,145 patients (890 male, 255 female; mean age 69.62 ± 8.42 years; BMI 26.62 ± 1.30) underwent conventional HCR. The robot-assisted group showed significantly higher rates of right coronary artery (RCA) stenosis (18.60% vs. 16.07%, p = 0.004) and drug-eluting stent use (62.68% vs. 5.42%, p = 0.027), along with significantly shorter hospital stays (4.27 ± 1.34 vs. 10.27 ± 7.34 days, p = 0.001). Although not statistically significant, wound complications were more frequent in the robot-assisted cohort (0.66% vs. 0.09%), whereas pleural effusion (10.74% vs. 0.00%), pericardial effusion (0.61% vs. 0.11%), and pneumothorax (1.83% vs. 0.11%) were more frequent in the conventional group. Mortality was low in both cohorts (robotic vs. conventional): intra-operative (0% vs. 0.09%, p = 0.73), 30-day (0.44% vs. 0.70%, p = 0.82), follow-up (2.66% vs. 4.72%, p = 0.41).
Conclusion:
Hybrid coronary revascularization offers a less invasive alternative with potential benefits. Robotic assistance may enhance outcomes, but limited adoption and heterogeneous data underscore the need for further investigation and validation.
