ArticleJTCVS techniques2026
Dark sides and warm rides: Is cardiopulmonary bypass necessary for grafting posterior wall targets in robotic totally endoscopic coronary bypass?
Article in JTCVS techniques, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Robotic off-pump totally-endoscopic coronary artery bypass (TECAB) is the least-invasive form of surgical coronary revascularization. It allows for sternal-sparing, multivessel, total-arterial revascularization. Although most published series focus on anterior-wall targets, little is known about the feasibility and outcomes of posterior wall grafting. We sought to evaluate this in a robotic beating-heart TECAB series with grafting of posterior-wall, "dark side," targets. Methods: We retrospectively reviewed 137 (of a total 983) patients undergoing robotic beating-heart TECAB between July 2013 and August 2025 who underwent grafting to at least 1 posterior-wall target-defined as distal obtuse marginal (OM2/OM3), posterior descending, or posterolateral branch (of the RCA). Peripheral CPB was instituted selectively for hemodynamic intolerance. Results: Mean age was 66 ± 9.8 years; 16.8% were female; and ejection fraction ≤40% occurred in 15.3%. Multivessel TECAB was performed in 102 patients (74.5%); bilateral internal thoracic arteries were used in 98 of 102 (96.1%). Cardiopulmonary bypass was required in 5 patients (3.6%); there were no conversions to sternotomy. Operative time was 317 ± 72 minutes. Early outcomes included atrial fibrillation 10%, acute kidney injury 1.5%, stroke 0.7%, and in-hospital mortality 0.7%; hospital stay was 2.2 ± 0.8 days; and 97% were discharged home. Follow-up was 100% complete (47 ± 34 months); overall mortality was 15%, cardiac mortality 2.9%, myocardial infarction 2.2%, and repeat revascularization 5.1% (all unplanned percutaneous coronary intervention). Freedom from major adverse cardiac and cerebrovascular events was 92%. Conclusions: In an experienced program, posterior-wall targets are not a contraindication to robotic beating-heart TECAB. These grafts can be performed safely with infrequent need for bypass, excellent early recovery, and durable midterm outcomes, expanding TECAB beyond anterior-wall-only revascularization.
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