Traditional coronary artery bypass graft versus totally endoscopic coronary artery bypass graft or robot-assisted coronary artery bypass graft - meta-analysis of 16 studies

BACKGROUND: Robot-assisted coronary artery bypass graft (RACAB) or totally endoscopic coronary artery bypass graft (TECAB) utilizing the da Vinci surgical system is increasingly used to treat coronary heart disease (CHD), although traditional coronary artery bypass graft (CABG) remains a classic treatment. The aim of the present study was to establish the advantages and disadvantages of TECAB (or RACAB) compared with traditional CABG. METHODS: PubMed and EBSCO databases were searched for studies of TECAB (or RACAB) using the da Vinci surgical system and CABG for CHD. The meta-analysis included 16 studies (2290 patients). RESULTS: Compared with traditional CABG, TECAB (or RACAB) had lower rates of major adverse cardiac or cerebrovascular events (MACCE) 12 months postprocedure (7.0% vs. 12.4%; odds ratio [OR], 0.53; confidence interval [CI], 0.38-0.74; p < 0.05). Subgroup analysis highlighted the differences between TECAB and RACAB as follows: TECAB decreased the rate of renal failure requiring hemofiltration (OR, 0.25; CI, 0.07-0.88), wound infection (OR, 0.11; CI, 0.11-1.99), and stroke (OR, 0.14; CI, 0.02-0.77) during follow-up, but increased the need for re-exploration for bleeding and MACCE (OR, 2.18; CI, 1.14-4.16; p < 0.05). CONCLUSIONS: TECAB and RACAB are safe and feasible therapies for CHD. This meta-analysis supports TECAB(or RACAB) using the da Vinci surgical system to treat CHD with reduced MACCE after 12 months. In addition, TECAB and RACAB do not increase the rates of MACCE in hospital, graft stenosis (or occlusion), and the need for reintervention compared with CABG.