{"title":"Robotic-assisted coronary artery bypass grafting: comparative analysis of surgical outcomes and learning curve.","authors":"Karana Shekar, Pradeep Narayan, Vikneswaran Gunaseelan, Roshni Vinosha, Mohammed Maaz, Devi Prasad Shetty, Raghu Maruti Govindappa","doi":"10.1007/s12055-025-02123-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>Data on outcome for robotic coronary artery bypass grafting (CABG) is sparse. The aim of this study was to compare clinical outcomes between conventional and robotic-assisted CABG.</p><p><strong>Methods: </strong>This was a single-center retrospective study comparing conventional and robotic-assisted CABG between January 2024 and October 2024. Baseline patient characteristics, intra-operative details, and post-op outcomes were compared between 2488 conventional and 136 robotic procedures. Propensity matching was done for age, gender, comorbid illness, and operative characteristics. Learning curve was analyzed using a cumulative sum (CUSUM) chart.</p><p><strong>Results: </strong>One hundred and thirty-two propensity-matched pairs were compared. Before matching, the conventional CABG group had a higher frequency of females and diabetes mellitus, and a slightly higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) 2 risk score, while ejection fraction was marginally higher in the robotic surgery group. After matching, the groups were comparable in terms of demographic details, clinical presentation, comorbid illness, and laboratory parameters. The duration of surgery, ventilation duration, and the number of distal anastomoses were higher in the conventional group before matching. After matching, the difference persisted for ventilation duration alone. Patients in the robotic-assisted CABG group had a lower incidence of arrhythmia (5.3% versus (vs.) 18.2%; <i>p</i> < 0.001). There was no difference in other post-op outcomes (renal complications, post-op myocardial infarction, extracorporeal membrane oxygenation (ECMO) requirement, and mortality). CUSUM analysis showed achievement of learning at the 86th patient, proficiency at the 114th patient, and competency by the 136th patient (<i>R</i> <sup>2</sup> 0.88).</p><p><strong>Conclusion: </strong>Our study demonstrates that robotic-assisted CABG is a feasible and effective approach in appropriately selected patients. Long-term outcomes, particularly graft patency and completeness of revascularization, require further investigation before definitive conclusions can be drawn regarding its superiority over conventional CABG.</p><p><strong>Clinical significance: </strong>Robotic CABG is a promising alternative to conventional techniques with potential clinical benefits and should form part of the surgical armamentarium.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02123-2.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 6","pages":"698-711"},"PeriodicalIF":0.6000,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179984/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-025-02123-2","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/2/7 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Aim: Data on outcome for robotic coronary artery bypass grafting (CABG) is sparse. The aim of this study was to compare clinical outcomes between conventional and robotic-assisted CABG.
Methods: This was a single-center retrospective study comparing conventional and robotic-assisted CABG between January 2024 and October 2024. Baseline patient characteristics, intra-operative details, and post-op outcomes were compared between 2488 conventional and 136 robotic procedures. Propensity matching was done for age, gender, comorbid illness, and operative characteristics. Learning curve was analyzed using a cumulative sum (CUSUM) chart.
Results: One hundred and thirty-two propensity-matched pairs were compared. Before matching, the conventional CABG group had a higher frequency of females and diabetes mellitus, and a slightly higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) 2 risk score, while ejection fraction was marginally higher in the robotic surgery group. After matching, the groups were comparable in terms of demographic details, clinical presentation, comorbid illness, and laboratory parameters. The duration of surgery, ventilation duration, and the number of distal anastomoses were higher in the conventional group before matching. After matching, the difference persisted for ventilation duration alone. Patients in the robotic-assisted CABG group had a lower incidence of arrhythmia (5.3% versus (vs.) 18.2%; p < 0.001). There was no difference in other post-op outcomes (renal complications, post-op myocardial infarction, extracorporeal membrane oxygenation (ECMO) requirement, and mortality). CUSUM analysis showed achievement of learning at the 86th patient, proficiency at the 114th patient, and competency by the 136th patient (R2 0.88).
Conclusion: Our study demonstrates that robotic-assisted CABG is a feasible and effective approach in appropriately selected patients. Long-term outcomes, particularly graft patency and completeness of revascularization, require further investigation before definitive conclusions can be drawn regarding its superiority over conventional CABG.
Clinical significance: Robotic CABG is a promising alternative to conventional techniques with potential clinical benefits and should form part of the surgical armamentarium.
Graphical abstract:
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02123-2.
目的：关于机器人冠状动脉旁路移植术（CABG）预后的数据很少。本研究的目的是比较传统和机器人辅助冠脉搭桥的临床结果。方法：这是一项单中心回顾性研究，比较了2024年1月至2024年10月期间的传统和机器人辅助CABG。对2488例常规手术和136例机器人手术的基线患者特征、术中细节和术后结果进行了比较。对年龄、性别、合并症和手术特征进行倾向匹配。学习曲线分析采用累积和（CUSUM）图。结果：比较了132对倾向配对。配对前，常规CABG组女性和糖尿病发生率较高，欧洲心脏手术风险评估系统（EuroSCORE） 2风险评分略高，而机器人手术组的射血分数略高。匹配后，两组在人口学细节、临床表现、合并症和实验室参数方面具有可比性。配型前常规组手术时间、通气时间、远端吻合次数均高于常规组。匹配后，仅通气时间的差异仍然存在。机器人辅助CABG组患者心律失常发生率较低(5.3% vs. 18.2%；p R 0.88)。结论：我们的研究表明，在适当选择的患者中，机器人辅助CABG是可行和有效的方法。长期结果，特别是移植物的通畅和血运重建的完整性，需要进一步研究才能得出其优于传统CABG的明确结论。临床意义：机器人冠脉搭桥是一种很有前途的替代传统技术，具有潜在的临床效益，应该成为手术装备的一部分。图片摘要：补充资料：在线版本包含补充资料，网址为10.1007/s12055-025-02123-2。
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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