Robot-assisted vs. conventional MIDCAB: A propensity-matched analysis

Abstract

BackgroundRobotic assistance (RA) in the harvesting of internal thoracic artery during minimally invasive direct coronary artery bypass grafting (MIDCAB) provides several potential benefits for surgeon and patient in comparison with conventional MIDCAB. The two technical options have not been thoroughly compared in the literature yet. We aimed to perform this in our cohort with the use of propensity-score matching (PSM).MethodsThis was a retrospective comparison of all consecutive patients undergoing conventional MIDCAB (2005–2021) and RA-MIDCAB (2018–2021) at our institution with the use of PSM with 27 preoperative covariates.ResultsThroughout the study period 603 patients underwent conventional and 132 patients underwent RA-MIDCAB. One hundred and thirty matched pairs were selected for further comparison. PSM successfully eliminated all preoperative differences. Patients after RA-MIDCAB had lower 24 h blood loss post-operatively (300 vs. 450 ml, p = 0.002). They had shorter artificial ventilation time (6 vs. 7 h, p = 0.018) and hospital stay (6 vs. 8 days, p < 0.001). There was no difference in the risk of perioperative complications, short-term and mid-term mortality between the groups.ConclusionsRA-MIDCAB is an attractive alternative to conventional MIDCAB. It is associated with lower post-operative blood loss and potentially faster rehabilitation after surgery. The mortality and the risk of perioperative complications are comparable among the groups.

A Single Center Initial Experience with Robotic-Assisted Minimally Invasive Coronary Artery Bypass Surgery (RA-MIDCAB)

“…Although conventional MIDCAB represents a feasible alternative to sternotomy, RA-MIDCAB provides highdefinition exposure that minimizes the access trauma of the LITA harvest by avoiding larger incisions and rib spreading, dislocation, or fractures. In addition, in accordance with previous experiences [22], as compared with conventional MIDCAB, the length of the graft is usually longer with the robotic harvesting technology and can be used for bilateral mammary artery revascularization.…”

Comparison of clinical effects of coronary artery bypass grafting between left anterior small thoracotomy approach and lower-end sternal splitting approach

“…8 As technology has continued to develop, minimally invasive direct CABG has rapidly advanced, including LESS CABG, video-assisted CABG, LAST CABG, robot-assisted CABG, and hybrid surgery. 9…”

“…8 As technology has continued to develop, minimally invasive direct CABG has rapidly advanced, including LESS CABG, video-assisted CABG, LAST CABG, robot-assisted CABG, and hybrid surgery. 9 Niinami et al 5 introduced off-pump CABG by the LESS approach. LESS CABG has the following advantages.…”

Robotic-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting: A Surgical Technique

“…In a recent paper, Gofus and colleagues compared conventional MIDCAB and RA-MIDCAB, demonstrating, at equal outcomes in terms of mortality and perioperative complications, the advantages associated with robotic platform use [11].…”