A systematic review on robotic coronary artery bypass graft surgery

Abstract

Background: Robotic-assisted coronary artery bypass graft surgery (CABG) has been performed over the past decade. Despite encouraging results from selected centres, there is a paucity of robust clinical data to establish its clinical safety and efficacy. The present systematic review aimed to identify all relevant clinical data on robotic CABG. The primary endpoint was perioperative mortality, and secondary endpoints included perioperative morbidities, anastomotic complications, and long-term survival.Methods: Electronic searches were performed using three online databases from their dates of inception to 2016. Relevant studies fulfilling the predefined search criteria were categorized according to surgical techniques as (I) totally endoscopic coronary artery bypass without cardiopulmonary bypass (TECAB offpump); (II) TECAB on-pump; and robotic-assisted mammary artery harvesting followed by minimally invasive direct coronary artery bypass (robotic MIDCAB).Results: The present systematic review identified 44 studies that fulfilled the study selection criteria, including nine studies in the TECAB off-pump group and 16 studies in the robotic MIDCAB group.Statistical analysis reported a pooled mortality of 1.7% for the TECAB off-pump group and 1.0% for the robotic MIDCAB group. Intraoperative details such as the number and location of grafts performed, operative times and conversion rates, as well as postoperative secondary endpoints such as morbidities, anastomotic complications and long-term outcomes were also summarized for both techniques.Conclusions: A number of technical, logistic and cost-related issues continue to hinder the popularization of the robotic CABG procedure. Current clinical evidence is limited by a lack of randomized controlled trials, heterogeneous definition of techniques and complications, as well as a lack of robust clinical followup with routine angiography. Nonetheless, the present systematic review reported acceptable perioperative mortality rates for selected patients at specialized centres. These results should be considered as a useful benchmark for future studies, until further data is reported in the form of randomized trials.

Robotic beating-heart totally endoscopic coronary artery bypass

“…Beating-heart totally endoscopic bypass surgery does offer a valid alternative to conventional revascularization strategies. Indeed perioperative outcomes such as myocardial infarction, stroke, acute kidney injury, bleeding, atrial fibrillation and mortality were comparable to conventional surgery (2).…”

The father of coronary artery bypass grafting: René Favaloro and the 50th anniversary of coronary artery bypass grafting

“…48 In addition, lack of robust clinical and angiographic data and a number of technical, logistic, and cost-related barriers have hindered popularization of robotic CABG. 49 Favaloro, Sones, and their colleagues embodied one of the earliest examples of the heart team. Favaloro explicitly remarked: ''.for I have always believed in teamwork.…”

A comprehensive multimodality heart motion prediction algorithm for robotic‐assisted beating heart surgery

“…Robotic‐assisted coronary artery bypass graft (CABG) surgery has been progressively developed over the past two decades. Thousands of successful CABG surgeries have been performed using the da Vinci surgical robot (Intuitive Surgical, Sunnyvale, CA) using three different surgical techniques: (a) totally endoscopic coronary artery bypass on arrested heart with cardiopulmonary bypass machine (TECAB on‐pump), (b) TECAB on confined heart with a heart stabilizer (TECAB off‐pump), and (c) robotic‐assisted internal mammary artery harvesting, followed by off‐pump anastomosis through minimally invasive direct coronary artery bypass (robotic MIDCAB) …”

“…The ultimate goal of robotic‐assisted CABG is to perform safe and effective coronary anastomoses using minimally invasive approaches in order to enhance the recovery process and minimize the trauma. Although cardiopulmonary bypass allows operating on an arrested heart, the peripheral cannulation and aortic clamping prolong the operation time and can cause complications such as groin wound infections and vascular injuries . With the TECAB off‐pump and robotic MIDCAB techniques, the coronary anastomoses are performed on a beating heart that is confined by a cardiac stabilizer.…”