Extending the Indications for Full Revascularization with Robotic-Assisted Coronary Artery Bypass

Coronary artery bypass grafting via median sternotomy carries considerable morbidity, and minimally invasive robotic approaches have been increasingly performed for surgical revascularization of coronary arteries. We report our institutional experience in robotic-assisted minimally invasive coronary revascularization in a broad patient population with complex multivessel disease. We retrospectively reviewed robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) procedures performed at our center between January 2022 and June 2026. Patient demographics, additional procedures and in-hospital outcomes were recorded. A total of 242 patients were included (mean age 63.4 ± 9.7 years; 31 (12.8%) female). Single-vessel bypass was performed in 25 (10.3%) patients; 212 (87.6%) patients underwent an operation on the arrested heart (mean cross-clamp time 66.9 ± 21.7 min) and 15 (6.2%) received an off-pump operation (mean CPB time in on-pump patients 155.7 ± 46.0 min). Full arterial revascularization was achieved in 42 (17.4%) patients; a bilateral internal mammary artery configuration was used in 9 (3.7%) patients. Coronary endarterectomy was performed in 16 (6.6%) patients and concomitant left atrial appendage (LAA) occlusion was performed in three (1.2%) patients. Epiaortic ultrasonography-guided clamp placement was performed in 27 (11.2%) patients with ascending-aortic plaque. In-hospital mortality occurred in two (0.8%) patients; no patient sustained a major neurological deficit, and the transfusion rate was 9.9%. Mean ventilation time was 4.0 (3.0-6.0) hours and mean intensive care unit stay was 22.6 ± 11.2 h. With careful planning and accumulated experience, the indications for robotic-assisted minimally invasive revascularization can be extended to include patients who require full-arterial revascularization, have ascending aortic plaques, complex coronary disease requiring endarterectomy, or atrial fibrillation where concomitant left atrial appendage occlusion is indicated.