SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
This article is part of the Research TopicAdvancements in Techniques for High-Risk Coronary RevascularizationView all articles
Conventional Hybrid Coronary versus Robot-assisted Minimally Invasive Direct Revascularization: A Meta-Analysis and Systematic Review
Provisionally accepted
Carla L Schuering1*
Vanessa IT Zwaans1
Anna Huang1Melanie Köhler-Seuster1Johanna KR von Mackensen1
Jasper Iske1
Julia Stein1
Julius Kaemmel1,2
Roland Heck1Christoph T Starck1,2Jörg Kempfert1,2Stephan Jacobs1,2Volkmar Falk1,2,3,4
Leonhard Wert1- 1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite, Berlin, Germany
- 2Deutsches Zentrum fur Herz-Kreislauf-Forschung eV, Berlin, Germany
- 3Department of Cardiothoracic Surgery, Charite - Universitatsmedizin Berlin, Berlin, Germany
- 4Department of Health Sciences and Technology, Eidgenossische Technische Hochschule Zurich, Zürich, Switzerland
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Objectives Hybrid coronary revascularization (HCR), a revascularization strategy that amalgamates the minimally invasive direct coronary artery bypass (MIDCAB) procedure and percutaneous coronary intervention (PCI), represents a significant advancement in coronary artery disease treatment. This study compares conventional and robotic approaches in HCR. Methods A systematic literature review and individual patient data analysis was conducted via PubMed following PRISMA guidelines, including original works published until 28 February 2025. Results 32 publications met the inclusion criteria, providing individual data from 2,048 patients. All patients underwent MIDCAB for LAD lesions and perioperative PCI for non-LAD lesions. 903 patients (670 male, 233 female; mean age 51.69 ±7.77 years; BMI 34.66 ±13.13) were treated with robot-assisted HCR, whilst 1,145 patients (890 male, 255 female; mean age 69.62 ±8.42 years; BMI 26.62 ±1.30) underwent conventional HCR. The robot-assisted group showed significantly higher rates of right coronary artery (RCA) stenosis (18.60% vs. 16.07%, p = 0.004) and drug-eluting stent use (62.68% vs. 5.42%, p = 0.027), along with significantly shorter hospital stays (4.27 ± 1.34 vs. 10.27 ± 7.34 days, p = 0.001). Although not statistically significant, wound complications were more frequent in the robot-assisted cohort (0.66% vs. 0.09%), whereas pleural effusion (10.74% vs. 0.00%), pericardial effusion (0.61% vs. 0.11%), and pneumothorax (1.83% vs. 0.11%) were more frequent in the conventional group. Mortality was low in both cohorts (robotic vs. conventional): intra-operative (0% vs. 0.09%, p = 0.73), 30-day (0.44% vs. 0.70%, p = 0.82), follow-up (2.66% vs. 4.72%, p = 0.41). Conclusion Hybrid coronary revascularization offers a less invasive alternative with potential benefits. Robotic assistance may enhance outcomes, but limited adoption and heterogeneous data underscore the need for further investigation and validation. Keywords: Hybrid Coronary Revascularization MIDCAB; Hybrid MIDCAB; HCR MIDCAB; PCI MIDCAB
Keywords: Hybrid coronary revascularisation, MIDCAB, PCI - Percutaneous Coronary Intervention (PCI), Hybrid, HCR, Hybrid MIDCAB
Received: 19 Jun 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Schuering, Zwaans, Huang, Köhler-Seuster, von Mackensen, Iske, Stein, Kaemmel, Heck, Starck, Kempfert, Jacobs, Falk and Wert. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Carla L Schuering, carlalouise.schuering@st.hunimed.eu
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