Early outcomes and follow-up of robotic-assisted multivessel coronary artery bypass with in situ bilateral internal thoracic artery: Report of 221 patients in a single center.

OBJECTIVE

Robotic-assisted harvesting of bilateral internal thoracic arteries offers significant advantages, and bilateral internal thoracic arteries grafting improves outcomes. This study retrospectively examined early clinical outcomes and follow-ups of patients who underwent robotic-assisted coronary artery bypass grafting with in situ bilateral internal thoracic arteries as a standardized technique in a single center.

METHODS

Between April 2021 and June 2024, 369 consecutive patients underwent robotic-assisted coronary artery bypass grafting at our center, including 221 (59.9%) with in situ bilateral internal thoracic arteries. Skeletonized bilateral internal thoracic arteries harvesting was performed using a robotic system, followed by off-pump hand-sewn distal anastomoses accessed via a 4- to 6-cm left thoracotomy. A radial artery was harvested in 63 patients (28.5%) as a third conduit, forming a composite I-graft. Angiography was performed before discharge to confirm graft patency. The primary end points were major adverse cardiac/cerebrovascular events and all-cause mortality.

RESULTS

Among 221 patients, the number of grafts was 2, 3, and 4 or more vessels in 124 patients (56.1%), 64 patients (29.0%), and 33 patients (14.9%), respectively. Hybrid therapy was performed in 9 (4.1%) cases. There was 1 (0.5%) conversion to peripheral cardiopulmonary bypass, no sternotomy conversions, and 1 (0.5%) postoperative death. Perioperative morbidity included 12 (5.5%) transfusions and 10 (4.5%) reexplorations for bleeding or revascularization. The postoperative graft angiography was performed on 216 patients (97.7%) and revealed an overall graft patency rate of 97.1% (545/561). The 12-month survival was 98.5%, with major adverse cardiac/cerebrovascular event-free survival at 97.1%.

CONCLUSIONS

Robotic-assisted coronary artery bypass grafting with in situ bilateral internal thoracic arteries is a safe, effective, and minimally invasive alternative to sternotomy coronary artery bypass grafting, achieving total arterial revascularization and potentially improving long-term survival.