Mid-term Outcomes After Robotic Coronary Artery Bypass Grafting in the United States

Use of robotic assistance in coronary artery bypass grafting (CABG) has remained stagnant and long-term comparative outcomes at the population level are unknown. We compared outcomes at 5 years for robotic vs nonrobotic CABG in the United States.

The Centers for Medicare and Medicaid database validated against clinical records was used to identify 12,571 adults, 65 years old or older who underwent first time, isolated, single or bilateral internal thoracic artery CABG from 2012 to 2022 in the United States. Of these, 10,307 (82%) underwent nonrobotic CABG and 2264 (18%) underwent robotic CABG. Propensity score matching was performed on 25 baseline characteristics with matching on year of surgery and number of bypasses. The primary end point was occurrence of major adverse cardiac events defined as death, acute myocardial infarction, or repeat revascularization at 5 years. The secondary end point was all-cause mortality at 5 years.

Matching yielded 2042 patient pairs (mean age 73 years; 26% female; 94% single-vessel bypass). Thirty-day mortality did not significantly differ between groups (1.3% vs 2.0%; P = 0.11). Robotic CABG was associated with lower rates of postoperative atrial fibrillation (18.8% vs 22.2%; P = 0.007) and a shorter hospital stay (median, 5 days [interquartile range, 3-6] vs 5 days [interquartile range, 4-7], P < 0.001). At 5 years, the cumulative incidence of major adverse cardiac events (30.1% vs 31.9%; hazard ratio, 0.95; 95% confidence interval, 0.84-1.08; P = 0.45) was similar, but the cumulative incidence of death (22.0% vs 25.9%; hazard ratio, 0.83; 95% confidence interval, 0.72-0.96; P = 0.01) was lower in the robotic group.

Robotic CABG in the United States is safe, with comparable perioperative outcomes and durable midterm survival relative to conventional CABG.