Robotic coronary artery surgery: Outcomes and pitfalls

Abstract

Objective: Coronary artery bypass grafting is one of the most commonly performed surgical procedures in cardiovascular surgery with a steadily evolving minimally invasive approach. Methods: Conventional coronary artery bypass grafting (CABG) is performed traditionally via midline sternotomy. Exciting advancements in technology and engineering over the last two decades have resulted in the transition from conventional to minimally invasive CABG including robotically assisted surgery. Results: The minimally invasive techniques are continuously striving to promote coronary revascularization into the arena of minimally invasive surgery. Examination of 10 previously completed studies with relevant follow-up periods enables an insightful vision into the outcomes and pitfalls surrounding robot-assisted CABG (RACAB) as explored in this review. Studies indicate that RACAB is associated with decreased postoperative complications such as major adverse cardiac or cerebrovascular events without compromise in survival rates. Despite this, certain drawbacks such as incurring costs and technical complexity of the procedure cannot be dismissed. Conclusion: There exist patient-related benefits from minimally invasive techniques such as decreased certain postoperative complications. Furthermore, with experience and a specialized stepwise program, it is possible to perform the entire procedure from the console. However, certain pitfalls involving increased expenses, steep learning curve and the lack of proper haptic feedback currently withhold the worldwide expansion of RACAB and limit it to specialized institutions only.

Robotically assisted coronary artery bypass graft surgery versus drug‐eluting stents for patients with stable isolated proximal left anterior descending disease

“…R‐CABG adopts low‐burning electric knife (10 W), which allow to skeletonize the internal mammary artery less injured, to reduce pain and dysesthesia and improve sternal perfusion 24 . Furthermore, compared with CCABG and MIDCAB, R‐CABG has many advantages such as tiny incision, faster recovery and good cosmetic effect, which should be considered as the preferred choice for the revascularization strategy of iLAD patients 25 . In the future, with the continuous development of engineering technology, robotic heart surgery will become a medical routine to serve more clinical patients 26,27 …”

“…24 Furthermore, compared with CCABG and MIDCAB, R-CABG has many advantages such as tiny incision, faster recovery and good cosmetic effect, which should be considered as the preferred choice for the revascularization strategy of iLAD patients. 25 In the future, Abbreviations: CI, confidence interval; HR, hazard ratio; MACCE, main adverse cardiac and cerebral events; PCI, percutaneous coronary intervention; R-CABG, robotically assisted coronary artery bypass graft; r-TLR, repeat target lesion revascularization.…”

Myocardial surgical revascularization as a subspecialty: to be or not to be, that is the question

“…The field of CABG surgery has not seen a similar transition, but minimal-access, robotic-assisted, and hybrid revascularization techniques have been described. While there are no data from randomized controlled trials, observational studies confirm these methods are safe and effective in selected cases and may positively influence postoperative pain, rate of sternal wound infection, and in-hospital length of stay [36][37][38] . Although these results may look promising when performed in specialized centers by highly skilled surgeons, their up-take by the wider community has been very low, probably due to the added costs, complexity, and steep learning curve [35,[39][40][41][42] [Table 1].…”

Peripheral extracorporeal membrane oxygenation support expands the application of robot-assisted coronary artery bypass

“…RCAB outcomes are equivalent to MIDCAB with a 93.4% graft patency rate at 8 years, 6 0.6% to 1.6% mortality at 30 days, 7 0.3% to 1.5% stroke rate at 30 days, 7 and 1% to 11% rate of repeat vascularization. 8 Consistent with the challenges of MIDCAB, RCAB is generally not applicable to higherrisk patients who cannot tolerate single-lung ventilation due to poor pulmonary reserve, reduced cardiac function, prior cardiac surgery, challenging chest wall anatomy, and critical coronary artery disease.…”