OBJECTIVES Robotic off-pump totally endoscopic coronary artery bypass (TECAB) is the least invasive form of surgical coronary revascularization. It has proved to be highly effective and safe. Its benefits are well-established and include fewer complications, shorter hospital stay and quicker return to normal activities. TECAB has undergone 2 decades of technological advancement to include multivessel grafting, a beating-heart approach and successful completion in multiple patient groups in experienced hands. The aim of this report was to examine outcomes of robotic off-pump TECAB at our institution over 7 years. METHODS Data from 544 patients undergoing TECAB between July 2013 and August 2020 were retrospectively examined. The C-Port Flex-A distal anastomotic device was used for the majority of grafts (70%). Yearly follow-up was conducted. Angiographic early patency data were reviewed for patients undergoing hybrid revascularization. RESULTS The mean age was 66 years, with 1.7% mean STS risk. Fifty-six percentage had multivessel TECAB. There was 1 conversion to sternotomy, and 46% extubation in the Operating Room (OR). Mortality was 0.9%. Early graft patency was 97%. At mid-term follow-up at 38 months, cardiac mortality was 2.7% and freedom from major adverse cardiac events was 92.5%. CONCLUSIONS We conclude that robotic beating-heart TECAB in the current era is safe and effective with excellent outcomes and comparable early angiographic patency to standard coronary artery bypass grafting surgery when performed frequently by an experienced team. This procedure was completed in our hands both with and without an anastomotic device. Longer-term studies are warranted.

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Objective: The benefits of Enhanced Recovery After Surgery (ERAS) protocols are being recognized in multiple surgical specialties, including following coronary bypass surgery to improve quality of care and decrease costs. We developed a fast-track discharge protocol for patients undergoing robotic totally endoscopic coronary bypass surgery (TECAB) to be discharged on postoperative day (POD) 1, the subjects of this study. Methods: In a retrospective study of 720 patients undergoing robotic beating-heart TECAB over 8 years at our institution, 93 patients were selected for a fast-track POD1 discharge protocol. We compared the outcomes of this group to the remaining 627 patients who were discharged per standard protocol (non-POD1 discharge). Results: The early discharge group was significantly younger, had lower Society of Thoracic Surgeons (STS) risk of mortality, and had a lower prevalence of obesity, diabetes, and chronic kidney disease. Patients discharged on POD1 were more often extubated in the operating room (56% vs 42%, P = 0.010). The readmission rate for the early discharge group was 3.2%, which was similar to the readmission rate of 6.7% for the standard discharge protocol group ( P = 0.329). Time to return to work was shorter in the early discharge group, although it did not quite reach statistical significance (12 vs 18 days, P = 0.051). There was no difference in midterm cardiac mortality. Conclusions: Early discharge on POD1 after robotic TECAB is appropriate in selected patients and is associated with low readmission rates and a trend towards earlier return to work. Patients suitable for this “ultrafast-track” approach were more likely to be younger, have lower STS risk, and fewer comorbidities.