Clinical Outcomes of Robotic-Assisted Coronary Artery Bypass Grafting.

A. Dokollari¹, S. Sicouri², B. Ramlawi³, N. Ghoparde¹, M. Wertan⁴, F. Sutter^5
1St. Boniface Hospital, Winnipeg, Manitoba ²Lankenau Institute for Medical Research, Wynnewood, Pennsylvania ³Lankenau Heart Institute, Wynnewood, Pennsylvania ⁴Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania ⁵Lankenau Medical Center, Wynnewood, Pennsylvania

Purpose: We aim to analyze single-surgeon experience in robotic-assisted coronary artery bypass grafting (CABG).

Methods: All consecutive 2,280 patients undergoing robotic-assisted CABG from a single surgeon between 05/2005-07/2021 were included.

The cohort was divided into 3 subgroups of five-years each (group A=2005-2010; B=2011-2016; C=2017-2021).

A propensity-adjusted matching was used for the analysis which adjusted during the modeling process (including follow-up).

All patients had at least one follow-up.

Results: We included 615, 904, and 761 patients in each group. Mean age was 65.4, 65.8, and 68.1 year-old, respectively. Mean STS-PROM values were 0.9, 0.8, and 0.9%, respectively.

Intraoperatively, 54.5, vs 47, vs 39% (p <.0001) of patients had multiarterial CABG. Conversion to sternotomy rates did not change from 1.8, to 1.7, to 1.5% (p=0.5), respectively. Mean OR time (hours) decreased (6.4, vs 6.2, vs 5.5) (p <.0001) in the three periods.

Postoperatively, prolonged ventilation time >24 hours (p=0.03), acute kidney failure (p=0.002), and platelet transfusion units (p=0.002) significantly decreased from the first to the second to the last period.

Thirty-day mortality was 1.5%, vs 1%, vs 0.9% (p=0.586) in each period. In addition, all population (three groups) repeat intervention on target vessel with percutaneous coronary intervention was 0.3%.

At follow-up, all-cause death (p < 0.0001), MACCE (p < 0.0002), stroke (p < 0.0001), and myocardial infarction (p=0.04), decreased from the first to the last period.

At follow-up, there were 2 surgical repeat surgical CABG revascularizations.

Repeat revascularization with stents decreased from 99/606 (16.3%), to 143/895 (16%), to 74/754 (9.8%) (p < 0.0001), respectively.

Conclusion: With increased surgeon experience, outcomes tend to improve over time with reduced mortality and reintervention.

Identify the source of the funding for this research project: no fundings