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Hybrid Revascularization With Robotic Totally Endoscopic Coronary Bypass and Stents: What Are the Outcomes When The

Sarah Nisivaco1, Hiroto Kitahara1, Sandeep Nathan1

  • 1Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois.

The Annals of Thoracic Surgery
|February 19, 2026
PubMed

Insights

Incomplete hybrid coronary revascularization (HCR) using robotic totally endoscopic coronary artery bypass (TECAB) did not impact midterm outcomes. Omitting percutaneous coronary intervention (PCI) in HCR is safe when dominant left-sided targets are addressed.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Minimally Invasive Cardiac Surgery

Background:

  • Hybrid coronary revascularization (HCR) combines coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for complete revascularization.
  • Incomplete HCR, where PCI is not completed, can occur in patients undergoing robotic beating-heart totally endoscopic coronary artery bypass (TECAB).
  • Outcomes for patients with incomplete HCR after robotic TECAB are not well-established.

Purpose of the Study:

  • To evaluate the outcomes of patients undergoing robotic TECAB-based HCR where the PCI component was not completed.
  • To compare early and midterm outcomes between patients who completed PCI and those who did not as part of HCR.

Main Methods:

  • Retrospective analysis of 418 intent-to-treat HCR patients undergoing robotic TECAB (July 2013 - June 2025).
  • Comparison of outcomes between 332 patients who completed PCI and 85 who did not, using propensity-score matching to create 82 balanced pairs.
  • Assessment of early outcomes, perioperative variables, midterm survival, and freedom from major adverse cardiac and cerebrovascular events (MACCE).

Main Results:

  • Early outcomes and survival at 5 years were similar between complete and incomplete PCI groups (cardiac survival: 95.7% vs 95.4%).
  • No significant differences in freedom from cardiac mortality, myocardial infarction, repeat revascularization, or MACCE were observed.
  • Incomplete PCI most frequently involved the right coronary artery or non-dominant circumflex lesions; no dominant left-sided targets were left unaddressed.

Conclusions:

  • Omission of PCI in HCR following robotic TECAB did not adversely affect midterm survival or adverse events in this propensity-matched cohort.
  • Careful patient selection and prioritizing revascularization of dominant left-sided coronary targets are crucial for successful HCR.
  • Further long-term follow-up studies are needed to fully elucidate the outcomes of incomplete HCR.
Abstract

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