Single-Center Initial Experience with Robotic Assisted Minimally Invasive Coronary Artery Bypass Surgery

Background: Robotic assisted minimally invasive direct coronary artery bypass grafting (RA-MIDCAB) represents an effective alternative to conventional coronary artery bypass grafting for revascularization of the left anterior descending artery (LAD) with the left internal thoracic artery (LITA). The first LITA-LAD bypass using a robot was performed in 1998. Since then, progress has been made, bringing the benefits of reduced surgical trauma and faster patient recovery. We report on our single-center initial experience of RA-MIDCAB surgery. Methods: This retrospective study included the first 27 patients who underwent RA-MIDCAB between July 2024 and September 2025. Baseline characteristics, perioperative and postoperative outcomes were collected from institutional databases and patient records. Results: All RA-MIDCAB procedures were successfully performed by 2 expert surgeons. Intraoperative graft patency was measured. No mortality was registered, neither on 30-day nor long-term. Conversion to sternotomy never occurred. The mean surgery time was 245.7 minutes. Early outcomes included postoperative new onset atrial fibrillation (n = 2; 7.4%) and respiratory failure (n = 1; 3.7%). Mean length of intensive care unit stay and hospital stay were, respectively, 2.4 and 3.9 days. No patients underwent repeat revascularization or suffered major adverse cardiovascular events. Conclusions: RA-MIDCAB surgery can be performed safely with excellent results. Despite an initial investment, starting a RA-MIDCAB program improves quality of care.