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OBJECTIVE: The efficacy of robotic assisted beating heart coronary artery bypass (rCAB) has not been fully demonstrated, and extensive studies are lacking. The aim of this analysis is to demonstrate that rCAB is a valuable and safe procedure that will significantly enhance the armamentarium of options for coronary bypass (CAB).
METHODS: All rCAB procedures were performed at a single institution by a single surgeon, May 2005 consecutively through November 2016 via non-rib spreading anterior mini- thoracotomy. We retrospectively examined 30-day Society of Thoracic Surgery (STS) data outcomes and also reveal some of the revascularization procedures possible with this sternal sparing robotic approach. Patients requiring conversion to sternotomy are included in this analysis as intention to treat.
RESULTS: Of 1503 rCAB, 41% had triple vessel disease, 38% had double, and 21% had single vessel disease. rCAB was performed to a single vessel in 76%, while 22% had double bypass rCAB. 67 patients had totally endoscopic CABG. Bilateral internal mammary arteries (IMA) were used in 80 patients. 578 patients underwent staged hybrid coronary revascularization. 90 patients had left main stenosis >70%. 37 patients had previous CAB. 9 patients had rCAB to the right coronary artery. 6 patients had rCAB and lysis of myocardial bridge. 6 patients had rCAB prior to transcatheter aortic valve replacement. There were 20 (1.2%) patients who were converted from robot to sternotomy for completion of procedure. Overall, rCAB comprised 45.1% of all institutional CAB performed by five surgeons during this study interval.

30 day OUTCOMES rCAB n=1503	May 1, 2005 - November 14, 2016
Extubated in the OR	87.2%
Prolonged ventilation >24 hours	2.2%
Stroke	0.26%
blood transfusion	18%
Postoperative atrial fibrillation	16%
Median hospital stay	4 days
Observed 30 day mortality	0.99%,
STS Predicted mortality risk	2.01% (Range: 0.153% - 35.94%)

CONCLUSIONS: The combination of beating heart, robotic-assisted CAB via non-rib spreading anterior mini-thoracotomy is a safe and efficacious procedure embraced by patients and cardiologists. rCAB fosters a team approach via collaboration with interventionalists resulting in individualized patient strategies, especially hybrid coronary revascularization. Additionally, high risk patients, not candidates for traditional CAB now have a viable surgical option. The significant volume of rCAB likely indicates successful long-term outcomes but additional studies are needed.