Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis

Figures

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  Figure 1. Learning curves. (A) For all 300 consecutive operations; (B,C,D) for the first 100 procedures of subgroups defined based on (B) tercile, (C) type of construct, (D) and hybrid versus non-hybrid procedures. Type of construct was subdivided into procedures including (I) SIMA +1 distal anastomosis, (II) SIMA +2 distal anastomoses, and (III) BIMA or more than 2 distal anastomoses. SIMA, single internal mammary artery; BIMA, bilateral internal mammary artery.

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  Figure 2. CUSUM analyses for MACCE complications. (A) For all 300 consecutive operations; (B,C,D) for the first 100 procedures of subgroups defined based on (B) tercile, (C) type of construct, (D) and hybrid versus non-hybrid procedures. Type of construct was subdivided into procedures including (I) SIMA +1 distal anastomosis, (II) SIMA +2 distal anastomoses, and (III) BIMA or more than 2 distal anastomoses. The red line represents the cumulative sum of complications, while the expected rate of complications and its 95% confidence boundaries are represented by the grey lines. CUSUM, cumulative sum; BIMA, bilateral internal mammary artery; MACCE, major adverse cardiac and cerebrovascular events; SIMA, single internal mammary artery.

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  Figure 3. CUSUM analyses for other complications. (A) For all 300 consecutive operations; (B,C,D) for the first 100 procedures of subgroups defined based on (B) tercile, (C) type of construct, (D) and hybrid versus non-hybrid procedures. Type of construct was subdivided into procedures including (I) SIMA +1 distal anastomosis, (II) SIMA +2 distal anastomoses, and (III) BIMA or more than 2 distal anastomoses. The red line represents the cumulative sum of complications, while the expected rate of complications and its 95% confidence boundaries are represented by the grey lines. CUSUM, cumulative sum; BIMA, bilateral internal mammary artery; SIMA, single internal mammary artery.