Comparison of Robot-Assisted Multivessel Minimally Invasive Direct Coronary Artery Bypass and Hybrid Revascularization

Abstract

Background: This study compares 2 minimally invasive coronary revascularization approaches: robot-assisted multivessel minimally invasive direct coronary artery bypass (MIDCAB) and the hybrid approach combining MIDCAB with subsequent percutaneous coronary intervention. Methods: A retrospective review was conducted on cases of robotic MIDCAB performed at our institution between 2012 and 2022. Two groups of patients were analyzed: the surgery group (undergoing robotic multivessel MIDCAB) and the hybrid group. Surgical procedures included robotic left internal mammary artery harvest and anastomosis, with percutaneous coronary intervention performed within 30 days in the hybrid group. Results: There were 105 patients in the surgery group and 81 patients in the hybrid group. Both groups had similar characteristics, except that the surgery group had older patients. There were no mortalities in either group. Postoperative atrial fibrillation rates were higher in the surgery group. Length of stay and other postoperative complications did not differ significantly between the groups. Conclusions: Multivessel robotic MIDCAB can be safely performed with comparable outcomes to the hybrid approach. The hybrid technique, being less demanding, is the preferred in most centers. However, multivessel robotic MIDCAB offers the advantage of complete revascularization and potentially more durable results. Patients with complex non-left anterior descending lesions may not be suitable for the hybrid approach.