Totally Endoscopic Coronary Artery Bypass Graft: Systematic Review and Meta-Analysis of Reconstructed Patient-Level Data

Objective: The standard approach for coronary artery bypass grafting is open surgery. Totally endoscopic coronary artery bypass has emerged as an alternative for selected patients. This meta-analysis sought to evaluate clinical outcomes with this emerging technique.Methods: A PRISMA-compliant search was performed up to December 14, 2022, in PubMed (MEDLINE), Scopus, and Cochrane. Time-to-event data were reconstructed using Kaplan-Meier curves from source literature.Results: A total of 2,774 patients with symptomatic coronary artery disease underwent totally endoscopic coronary artery bypass in 18 eligible studies. The mean patient age was 63.2 +/- 12.3 years, and 77.5% (95% confidence interval [CI]: 72.2% to 82.4%) of the included patients were males. The mean operative time was 304.2 +/- 155 min, whereas the mean internal mammary artery takedown time was 38.3 +/- 18.4 min. Of the patients, 4.7% (95% CI: 1.6% to 9.1%) required conversions to open surgery. The 30-day complication rate was 5.9% (95% CI: 1.2% to 13.1%), whereas late complications developed in 4.8% (95% CI: 1.9% to 8.5%) of the patients. Freedom from major adverse cardiac events was 93.4% (95% CI: 85.3% to 94.8%) and 1-year, 5-year, and 10-year survival rates were 95.2%, 83.2%, and 81.7%, respectively. Reintervention was required in 3.3% (95% CI: 2.3% to 4.4%) of the cohort within a mean follow-up of 42.5 +/- 27.8 months.Conclusions: Totally endoscopic coronary artery bypass may be a safe and viable alternative for selected patients with coronary artery disease. Long-term follow-up will help define the place of robotic endoscopic treatment in the armamentarium of myocardial revascularization.