Comparing Robotic-Assisted Coronary Artery Bypass Grafting Using the Da Vinci Surgical System to a Nonrobotic Approach: A Systematic Literature Review and Meta-Analysis
Author(s)
Neera Patel, MS1, Ana Yankovsky, MSc1, Usha Kreaden, MSc2.
1Intuitive Surgical, Sunnyvale, CA, USA, 2Managing Fellow, Biostatistics, Access & Evidence, Intuitive Surgical, Sunnyvale, CA, USA.
1Intuitive Surgical, Sunnyvale, CA, USA, 2Managing Fellow, Biostatistics, Access & Evidence, Intuitive Surgical, Sunnyvale, CA, USA.
OBJECTIVES: To compare the perioperative clinical outcomes of robotic-assisted (rCABG) to non-robotic coronary artery bypass grafting (non-rCABG).
METHODS: A PRISMA-guided literature review of studies from Pubmed, Scopus and Embase was conducted for publications between 01/01/2010 and 01/11/2024 (Prospero #CRD420250652462). Included studies reported on adults with coronary artery disease requiring revascularization, comparative studies including rCABG and non-robotic CABG, in the form of RCT, large database, prospective, and retrospective cohort studies with a sample size greater than 20 subjects in each arm and quantifiable perioperative safety and effectiveness outcomes. Data were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effects or random-effects.
RESULTS: The search identified 31 eligible studies (27 retrospective, 3 database, and 1 prospective), including 20,935 rCABG and 970,305 non-rCABG patients. Operative time was comparable between both groups. rCABG patients also experienced an 18% higher likelihood of reoperation due to bleeding (OR:1.18, [1.04, 1.34] p<0.01). Compared to non-rCABG, patients undergoing rCABG were 71% less likely to receive a postoperative blood transfusion (OR:0.29, [0.22, 0.39] p<0.01), had shorter ICU stay by 0.84 days (p<0.01), shorter hospital stay by 1.98 days ( p<0.01), were 39% less likely to have postoperative atrial fibrillation (OR: 0.61, [0.51, 0.73] p<0.01), 43% less likely to experience a stroke (OR: 0.57, [0.48, 0.69] p<0.01), and had less short term mortality (OR:0.68 [0.58, 0.78],p<0.01). Both groups had comparable rates of postoperative myocardial infarction and revascularization post-surgery.
CONCLUSIONS: This meta-analysis demonstrates that rCABG is safe and effective with numerous patient benefits over non-rCABG, but highlights gaps in high level evidence comparing rCABG to non-rCABG. These results nevertheless may be useful for decision-making by payors, policymakers, and Health Technology Assessment bodies.
METHODS: A PRISMA-guided literature review of studies from Pubmed, Scopus and Embase was conducted for publications between 01/01/2010 and 01/11/2024 (Prospero #CRD420250652462). Included studies reported on adults with coronary artery disease requiring revascularization, comparative studies including rCABG and non-robotic CABG, in the form of RCT, large database, prospective, and retrospective cohort studies with a sample size greater than 20 subjects in each arm and quantifiable perioperative safety and effectiveness outcomes. Data were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effects or random-effects.
RESULTS: The search identified 31 eligible studies (27 retrospective, 3 database, and 1 prospective), including 20,935 rCABG and 970,305 non-rCABG patients. Operative time was comparable between both groups. rCABG patients also experienced an 18% higher likelihood of reoperation due to bleeding (OR:1.18, [1.04, 1.34] p<0.01). Compared to non-rCABG, patients undergoing rCABG were 71% less likely to receive a postoperative blood transfusion (OR:0.29, [0.22, 0.39] p<0.01), had shorter ICU stay by 0.84 days (p<0.01), shorter hospital stay by 1.98 days ( p<0.01), were 39% less likely to have postoperative atrial fibrillation (OR: 0.61, [0.51, 0.73] p<0.01), 43% less likely to experience a stroke (OR: 0.57, [0.48, 0.69] p<0.01), and had less short term mortality (OR:0.68 [0.58, 0.78],p<0.01). Both groups had comparable rates of postoperative myocardial infarction and revascularization post-surgery.
CONCLUSIONS: This meta-analysis demonstrates that rCABG is safe and effective with numerous patient benefits over non-rCABG, but highlights gaps in high level evidence comparing rCABG to non-rCABG. These results nevertheless may be useful for decision-making by payors, policymakers, and Health Technology Assessment bodies.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
MT10
Topic
Clinical Outcomes, Medical Technologies, Study Approaches
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)