従来のハイブリッド冠動脈バイパス術 vs. ロボット支援下低侵襲直接血行再建術：メタアナリシスおよび系統的レビュー

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.

A systematic literature review and individual patient data analysis was conducted via PubMed following PRISMA guidelines, including original works published until 28 February 2025.

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).

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.