Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Systematic Review of Clinical Outcomes from the Past two Decades

Abstract

<jats:p> Robotic totally endoscopic coronary artery bypass grafting (TECAB) was introduced in 1998 and has over a period of two decades gradually emerged from single-vessel revascularization to multivessel bypass grafting. Dedicated centers have continuously evolved and further developed this minimally invasive method of coronary bypass surgery. A literature review was conducted to assess intra- and postoperative outcomes of TECAB. PubMed returned 19 comprehensive articles on TECAB. Investigation was focused on perioperative outcome parameters, i.e.: operative time, conversion to larger incision, revision for bleeding, atrial fibrillation, stroke, acute renal failure, and mortality. Outcome from the analysis of 2,397 reported cases showed an average operative time of 291 ± 57 minutes (range 112 to 1,050), conversion rate to larger incisions at 11.5%, and perioperative mortality at 0.8%. Pooled data demonstrated 4.2% operative revision rate due to postoperative hemorrhage, 1.0% stroke incidence, 1.6% acute renal failure, and 13.3% de novo atrial fibrillation. The mean length of hospital stay measured 5.8 ± 1.7 days. Conversion rates and operative times decreased over time. According to data in the literature, coronary bypass surgery carried out in completely endoscopic fashion utilizing robotic assistance can require relatively extensive operative times and conversion rates are somewhat higher than in other robotic cardiac surgery. However, major postoperative events lie in an acceptable range. TECAB remains the surgical revascularization method with the least tissue trauma and represents an opportunity for coronary artery bypass grafting via port access. Rates of major complications are at least similar to conventional surgical access procedures. </jats:p>

Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

“…Concerning learning curves similar to the MIDCAB procedure a triple digit number of repetitions is necessary for the individual surgeon and the team to achieve a good comfort level (79,80). For conversion a learning curve for the whole community of robotic heart surgeons has been described recently (81). Conversion rates affected almost one out of two patients in the early 2000s but nicely fell below 5% over the last years.…”

Toward stroke‐free coronary surgery: The role of the anaortic off‐pump bypass technique

“…They also provide a natural platform for the use of multiple arterial grafts and bilateral inflows in many patients, which is increasingly important as the evidence supporting improved long‐term survival accumulates 82 . In addition to a sternotomy‐based approach, anOPCAB can also be achieved using minimally invasive direct coronary artery bypass (MID‐CAB) 83 and totally endoscopic techniques (TECAB) with robotic assistance 84,85 in suitable patients.…”

Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization

“…With newer technical advancements, there are improvements in conversion rates, operative time, and the impact of the learning curve on the outcome. 37 …”

“… 38 Similar clinical outcomes were noted in recent systematic reviews by Göbölös and Cao. 37 , 39 Göbölös and colleagues analyzed a total of 2,397 TECAB cases with less than half being multivessel procedures. That study demonstrated an acceptable rate of perioperative mortality (0.8%) and perioperative major events such as stroke (1%), renal failure (1.6%), de novo atrial fibrillation (13.3%), and operative revision rate due to postoperative hemorrhage (4.2%).…”

“…However, this cohort had both beating heart and arrested heart TECAB patients who underwent the subsequent hybrid procedure (16.8% and 30.3%, respectively), thus the data cannot be extrapolated as being purely a TECAB study. 37 Cao and colleagues analyzed 9 beating heart TECAB studies with an average of fewer than 2 vessels bypassed. The results were similar in perioperative mortality rate (1.7%), perioperative MI rate (1.1%), stroke rate (1.1%), acute kidney injury rate (3.4%), and reoperation for bleeding rate (3.2%).…”