Robotic-assisted minimally invasive multivessel coronary artery surgery: a propensity-matched analysis

BACKGROUND: Robotic-assisted CABG is a minimally invasive alternative to conventional sternotomy. The purpose of this study was to evaluate the short and mid-term outcomes of our experience and to enrich the literature with quality comparisons of these procedures. METHODS: From 1 October, 2020 to 1 July, 2025, 927 CABG procedures were performed at a single institution. Two groups of patients were analyzed: the robotic assisted minimally invasive CABG group (RA-CABG) and the conventional sternotomy CABG group (CS-CABG). This was a retrospective comparison of all consecutive patients undergoing conventional CABG and RA-CABG with the use of propensity score matching with 24 preoperative covariates. Of the 927 cases, 480 patients were matched with 240 patients each in the RA-CABG and CS-CABG groups. RESULTS: The matching successfully eliminated all preoperative differences between the groups. There were three conversions to median sternotomy in the robotic group. Number of distal anastamoses per patient was 2.84 in the RA-CABG group and was 3.05 in the CS-CABG group. The cross clamp time and cardiopulmonary bypass time were statistically significantly shorter in the CS-CABG group (cross clamp: 59 vs. 47, minutes and CPB: 95 vs. 67, minutes, p = 0.001). The RA-CABG group had significantly (p < 0.001) lower 24-h postoperative blood loss (400 ml vs. 800 ml), fewer blood transfusion, shorter mechanical ventilation time (6 vs. 10, hours), shorter length of ICU stay (20 vs. 28, hours), shorter length of hospital stay (6 vs. 7, days). Early mortality (in-hospital and operative) rates were similar between the groups, 0.8% for RA-CABG and 1.3% for CS-CABG (p = 0.683). In like manner, there was no significant difference in mid-term mortality rates between the two groups (p = 0.258). CONCLUSIONS: The RA-CABG is safe and feasible alternative to the conventional sternotomy CABG. This method offers advantages such as avoiding sternotomy, providing greater comfort to the surgeon during LIMA harvesting, and enabling longer LIMA harvesting.