• Sarah Nisivaco, Hiroto Kitahara, Riya Bhasin, Brooke Patel, Charocka Coleman, and Husam H Balkhy.
• Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Ill.
• J. Thorac. Cardiovasc. Surg. 2024 Aug 6.

ObjectiveRobotic beating-heart totally endoscopic coronary bypass (TECAB) is performed using single or bilateral internal thoracic arteries with good results. Despite slow adoption and limited industry support, we have evolved our practice and continue to routinely perform TECAB. We describe our series of 874 patients undergoing robotic beating-heart TECAB with up to 10-year follow-up.MethodsA retrospective review of all patients (n = 874) undergoing robotic beating-heart TECAB (July 2013 to April 2024) was performed. Patients were contacted for midterm follow-up, and angiographic data were collected in those undergoing hybrid revascularization. Multivariate regression analysis and Cox proportional hazard modeling were used to analyze risk factors for early/midterm outcomes. Primary end points were midterm all-cause mortality and major adverse cardiac/cerebrovascular events.ResultsMean Society of Thoracic Surgeons score was 1.5 ± 2.2%. In total, 470 (54%) underwent multivessel TECAB, of whom 86% received bilateral internal thoracic arteries. There was 1 intraoperative conversion (0.11%). Mean length of stay was 2.3 ± 0.8 days. Hospital mortality was 0.80% (observed/expected 0.54). A total of 393 patients (45%) underwent hybrid revascularization. Early graft patency was 97% (left internal thoracic artery-left anterior descending artery patency 98%). Midterm follow-up was 100% at mean 48 months (longest 10.6 years). Cardiac-related mortality and all-cause mortality were 2.2% and 18%, respectively. Freedom from major adverse cardiac/cerebrovascular events was 93%. In multivariate analysis, left-main disease ≥70% was a risk factor for midterm cardiac mortality (odds ratio, 6.7; confidence interval, 1.9-24, P = .003).ConclusionsIn this series of 874 patients with up to 10-year follow-up, we show that robotic TECAB can be performed with excellent early and midterm results using an iterative approach, despite significant challenges. Further industry support and wider surgeon adoption are necessary to ensure sustainability of this procedure.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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