Robotic-assisted versus conventional coronary artery bypass grafting: a systematic review, meta-analysis, and trial sequential analysis of 39,918 patients.
Ahmed Abdelsamad, Ibrahim Khalil, Mohammed Hrebat et al.
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In 30 seconds
This systematic review and meta-analysis compared robotic-assisted with conventional coronary artery bypass grafting (CABG) across nine observational studies involving 39,918 patients. Robotic-assisted CABG was associated with lower mortality (OR 0.55, 95% CI 0.43-0.69; P < 0.001; I²=0%) and better results for several other short-term outcomes. Trial sequential analysis found conclusive evidence for mortality, atrial fibrillation, respiratory failure, and blood transfusion. Long-term outcome data were sparse, and the observational evidence cannot establish that the surgical approach caused the differences.
Key findings
- Mortality was lower with robotic-assisted CABG (OR 0.55, 95% CI 0.43-0.69; P < 0.001; I²=0%).
- Robotic-assisted CABG was associated with less atrial fibrillation (OR 0.53; P < 0.001), respiratory failure (OR 0.31; P < 0.001), and blood transfusion (OR 0.28; P < 0.001).
- Hospital stay was shorter (MD - 1.95 days; P < 0.001), as was ICU stay (MD - 22.7 h; P < 0.001).
- Stroke showed a non-significant trend favoring robotic-assisted CABG (OR 0.76; P = 0.071).
Why it matters
The findings suggest robotic-assisted CABG may be associated with better short-term outcomes across several clinically relevant measures. However, all included studies were observational, so differences may reflect patient selection or residual confounding rather than the procedure itself. Sparse long-term data also leave durability and later outcomes uncertain.
What to keep in mind
All nine included studies were observational, leaving potential residual confounding and case-selection bias; long-term outcome data were sparse.