Robotic-assisted coronary artery bypass grafting: comparative analysis of surgical outcomes and learning curve

Data on outcome for robotic coronary artery bypass grafting (CABG) is sparse. The aim of this study was to compare clinical outcomes between conventional and robotic-assisted CABG.

This was a single-center retrospective study comparing conventional and robotic-assisted CABG between January 2024 and October 2024. Baseline patient characteristics, intra-operative details, and post-op outcomes were compared between 2488 conventional and 136 robotic procedures. Propensity matching was done for age, gender, comorbid illness, and operative characteristics. Learning curve was analyzed using a cumulative sum (CUSUM) chart.

One hundred and thirty-two propensity-matched pairs were compared. Before matching, the conventional CABG group had a higher frequency of females and diabetes mellitus, and a slightly higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) 2 risk score, while ejection fraction was marginally higher in the robotic surgery group. After matching, the groups were comparable in terms of demographic details, clinical presentation, comorbid illness, and laboratory parameters. The duration of surgery, ventilation duration, and the number of distal anastomoses were higher in the conventional group before matching. After matching, the difference persisted for ventilation duration alone. Patients in the robotic-assisted CABG group had a lower incidence of arrhythmia (5.3% versus (vs.) 18.2%; p < 0.001). There was no difference in other post-op outcomes (renal complications, post-op myocardial infarction, extracorporeal membrane oxygenation (ECMO) requirement, and mortality). CUSUM analysis showed achievement of learning at the 86th patient, proficiency at the 114th patient, and competency by the 136th patient (R ² 0.88).

Our study demonstrates that robotic-assisted CABG is a feasible and effective approach in appropriately selected patients. Long-term outcomes, particularly graft patency and completeness of revascularization, require further investigation before definitive conclusions can be drawn regarding its superiority over conventional CABG.

Robotic CABG is a promising alternative to conventional techniques with potential clinical benefits and should form part of the surgical armamentarium.

The online version contains supplementary material available at 10.1007/s12055-025-02123-2.