The outcomes of robotic-assisted coronary artery bypass grafting surgery in the Atlantic demographic—a systematic review and meta-analysis of the literature

Background: Coronary artery bypass grafting has significantly reduced the morbidity and mortality of patients suffering from ischemic heart disease over its six decades of practice. In recent years, minimally invasive techniques have been increasingly described and utilized, with the promise of providing patients with the same standard of care without the need for the traditional full sternotomy, and in select cases without cardiopulmonary bypass, and thus providing improved recovery metrics. The present systematic review and meta-analysis sought to determine the outcomes of all patients receiving robotic-assisted coronary artery bypass grafting in an Atlantic patient demographic.
Methods: The methods for this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Four databases were searched, using appropriate search terminology. Meta-analysis using proportions or means, as appropriate, were applied, and were presented as per routine practice. Kaplan-Meier curves were digitized and aggregated using previously reported, validated techniques. Quality assessment and risk of bias of each study were assessed systematically. Patient populations were subcategorized as per established technical definitions.
Results: Thirty-five studies were identified through the literature search, with three studies having subgroupings appropriate for separate analysis (yielding 42 data points maximally). A total of 9,078 patients (69% male), with a mean age of 62.3 years, were identified across the study period. On actuarial assessment, survival at yearly assessment from 1-, 2-, 3-, 4- and 5-yearly intervals was determined to be 95%, 94%, 92%, 90%, and 88%, respectively.
Conclusions: The present systematic review and meta-analysis demonstrated that short-term mortality, operative time, and admission [intensive care unit (ICU) and overall length of stay] outcomes were encouraging in the Atlantic demographic. Freedom from long-term mortality assessment of a smaller cohort showed encouraging results. A major caveat to the present analysis is the high degree of heterogeneity in the reporting of data. Analysis of future randomized controlled trials will be vital in establishing these procedures as commonplace.