Totally Endoscopic Coronary Artery Bypass Graft: Systematic Review and Meta-Analysis of Reconstructed Patient-Level Data

Abstract

Objective: The standard approach for coronary artery bypass grafting is open surgery. Totally endoscopic coronary artery bypass has emerged as an alternative for selected patients. This meta-analysis sought to evaluate clinical outcomes with this emerging technique.

Methods: A PRISMA-compliant search was performed up to December 14, 2022, in PubMed (MEDLINE), Scopus, and Cochrane. Time-to-event data were reconstructed using Kaplan-Meier curves from source literature.

Results: A total of 2,774 patients with symptomatic coronary artery disease underwent totally endoscopic coronary artery bypass in 18 eligible studies. The mean patient age was 63.2 ± 12.3 years, and 77.5% (95% confidence interval [CI]: 72.2% to 82.4%) of the included patients were males. The mean operative time was 304.2 ± 155 min, whereas the mean internal mammary artery takedown time was 38.3 ± 18.4 min. Of the patients, 4.7% (95% CI: 1.6% to 9.1%) required conversions to open surgery. The 30-day complication rate was 5.9% (95% CI: 1.2% to 13.1%), whereas late complications developed in 4.8% (95% CI: 1.9% to 8.5%) of the patients. Freedom from major adverse cardiac events was 93.4% (95% CI: 85.3% to 94.8%) and 1-year, 5-year, and 10-year survival rates were 95.2%, 83.2%, and 81.7%, respectively. Reintervention was required in 3.3% (95% CI: 2.3% to 4.4%) of the cohort within a mean follow-up of 42.5 ± 27.8 months.

Conclusions: Totally endoscopic coronary artery bypass may be a safe and viable alternative for selected patients with coronary artery disease. Long-term follow-up will help define the place of robotic endoscopic treatment in the armamentarium of myocardial revascularization.

Keywords: CABG; cardiac surgery; coronary artery bypass graft; endoscopic; minimally invasive; robotic.

Visual abstract

Fig. 1.

Kaplan–Meier curve demonstrating overall freedom from reintervention constructed by individualized patient data. CI, confidence interval.

Fig. 2.

Kaplan–Meier curve demonstrating overall survival constructed by individualized patient data. CI, confidence interval.

Fig. 3.

Kaplan–Meier curve demonstrating overall freedom from MACCE survival constructed by individualized patient data. CI, confidence interval; MACCE, major adverse cardiac and cerebrovascular events.