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

This meta-analysis evaluates the clinical outcomes of totally endoscopic coronary artery bypass (TECAB) in patients with symptomatic coronary artery disease. A comprehensive search of PubMed, Scopus, and Cochrane was conducted, analyzing data from 18 eligible studies published up to December 2022, involving 2,774 patients. The average age of the patients was 63.2 years, and 77.5 percent were male.  The study found that the mean operative time for TECAB was 304.2 minutes, with an internal mammary artery takedown time of 38.3 minutes. Conversion to open surgery occurred in 4.7 percent of cases. Long-term outcomes were favorable, with 93.4 percent of patients remaining free from major adverse cardiac events (MACE). Survival rates were 95.2 percent at one year, 83.2 percent at five years, and 81.7 percent at 10 years. Additionally, 3.3 percent of patients required reintervention during a mean follow-up period of 42.5 months.  The findings suggest that TECAB is a safe and viable option for selected patients, offering favorable short-term and long-term outcomes. The technique is associated with relatively low complication rates, and its survival rates are comparable to those of traditional coronary artery bypass grafting (CABG). However, the need for further research with longer follow-up is emphasized to better understand the role of robotic and endoscopic approaches in coronary revascularization, especially in comparison to standard open surgery.