Aleksander Dokollari; Serge Sicouri; Ozgun Erten; William  A. Gray; Timothy  A. Shapiro; Frank McGeehin; Marwan Badri; Paul Coady; Eric Gnall; Mara Caroline; Amid  A. Khan; Stephanie Kjelstrom; Georgia Montone; Basel Ramlawi; Mary  Ann Wertan; Francis  P. Sutter; Gianluca Torregrossa

doi:10.4244/EIJ-D-23-00373

Long-term clinical outcomes of robotic-assisted surgical coronary artery revascularisation

Aleksander Dokollari¹, MD; Serge Sicouri², MD; Ozgun Erten², MD; William A. Gray³, MD; Timothy A. Shapiro³, MD; Frank McGeehin³, MD; Marwan Badri³, MD; Paul Coady³, MD; Eric Gnall³, MD; Mara Caroline³, MD; Amid A. Khan³, MD; Stephanie Kjelstrom⁴, MS; Georgia Montone⁴, MS; Basel Ramlawi¹^,², MD, FRCSC; Mary Ann Wertan¹, RN; Francis P. Sutter¹, DO, FACS; Gianluca Torregrossa¹^,², MD, MEBCTS, FACOS

Abstract

Background: Patients who are not candidates for traditional coronary artery bypass grafting (CABG) and amenable only for percutaneous coronary intervention (PCI) with stents can receive the “gold standard” left internal thoracic artery (LITA) to left anterior descending artery (LAD) anastomosis through robotic-assisted CABG and PCI to non-LAD coronary targets.

Aims: We aimed to analyse clinical outcomes of robotic-assisted CABG.

Methods: A total of 2,280 consecutive patients who had undergone robotic-assisted CABG between May 2005 and June 2021 were included in our study. Robotic-assisted LITA harvest was followed by LITA-LAD manual anastomosis through a 4 cm left thoracotomy. Hybrid coronary intervention (HCR) consists of stent implantation in a non-LAD coronary artery performed within 7 days after robotic-assisted LITA-LAD. We performed a propensity-adjusted analysis comparison after dividing all robotic-assisted CABG patients into three time periods: 2005-2010, 615 patients; 2011-2016, 904 patients; and 2017-2021, 761 patients.

Results: The mean age increased from 64.5 years in the first time period to 65.8 years in the second time period to 68.1 years in the third (p<0.0001). Operative time was progressively reduced in the three periods (6.4; 6.2; 5.5 hours; p<0.001). The incidence of conversion to sternotomy remained similar for each period (1.8%; 1.7%; 1.5%; p=0.53). Thirty-day mortality in the three periods included 9 (1.4%), 9 (1.0%), and 7 (0.9%) patients, respectively (p=0.91), while 8 (0.3%) patients had PCI with stents in the entire group. The mean follow-up for the entire population was 4.2 years. At follow-up, the rates of all-cause death, major adverse cardiac and cerebrovascular events, non-fatal stroke, and repeat revascularisation with stents were significantly decreased from the first to the last period (pË0.0001).

Conclusions: Robotic-assisted CABG and HCR provide good long-term outcomes in patients who are not candidates for conventional CABG.

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