ISMICS 2026 Annual Meeting

Comparative Analysis Of Graft Patency Of Robotic Vs Open Internal Mammary Artery Harvesting
Ankit Maheshwari1, Arunkumar Ulaganathan1 1Department of Cardiothoracic and Vascular Surgery,
KG Hospital, Coimbatore, India

BACKGROUND

•Left Internal Mammary Artery(LIMA) remains a conduit of choice for Coronary Artery Bypass Grafting (CABG).

•Robotic-Assisted LIMA harvesting1

•An alternative to open and Minimally Invasive techniques

•enhanced vision, lower blood loss and lesser tissue trauma.

•Growing adoption of RA-CABG by emerging robotic centers

•Large randomized studies, long-term follow-up are needed2

• This study compares graft flow characteristics of robotic LIMA harvesting for RA-CABG with conventional open LIMA harvesting for conventional CABG(cCABG) using Transit Time Flow Measurement(TTFM).

METHODS:

Retrospective single-center cohort study ; Feb 2024–June 2025

Group A(n=70) : RA-CABG with robotic LIMA harvesting

Group B(n=337) : cCABG with open LIMA harvesting

TTFM parameters

Mean graft flow (MGF),Pulsatility index (PI)

Diastolic filling percentage (DF%)

On follow up : readmission rates related to ischemia

RESULTS:

No statistically significant difference in graft flow parameters

cCABG: Mean 37.6 ml/min (SD 20.2), median 31.0.

RA-CABG: Mean 33.5 ml/min (SD 18.7), median 26.5.

Average PI (2.95 vs 3.03) and DF%(72.2% vs 72.9%), were similar within acceptable quality thresholds

ØBLOOD LOSS: significantly lower in Robotic group

qGroup A:

Port positioning:1 minimally soaked gauze

LIMA harvesting: median 1 gauze

qGroup B: cCABG

After sternotomy: 2 surgical mops

LIMA harvesting: : median 9 gauze

GRAFT HARVESTING TIME

Robotic group:

122 minutes in 1st patient

35 minutes in the last patient.

Readmission at 6 months related to ischemia:

Group A : Nil

Group B: 2

CONCLUSION:

comparable TTFM assessment: Similar graft flow parameters

Reduced blood loss

Progressive improvement in harvesting efficiency.

These findings support robotic LIMA harvesting as a safe and reliable alternative.

DISCUSSION

TTFM findings in this study suggest preserved graft integrity with robotic harvesting

Previous studies on Robotic assisted by angiographic findings

Yang et al : IMA graft patency - 97.1% in TECAB and 96.4 % in MINICAB over 3 years3

Halkos et al: before discharge, LIMA patent 95.0%4

Curre et al: patency rate of LIMA to LAD was 93.4% at 8 years5

Hwang B et al: meta-analyses: 96% at 5.2 years both RA-MIDCAB and TECAB6

Robotic LIMA harvest: Further studies are required to establish non-inferiority to conventional CABG2

Limitations:

Retrospective, Single center, short term study, limited data

Conflict of interest: Nil

REFERENCES

1.Kok Wah, Jack Ng. (2025). The robotic revolution in cardiac surgery. Journal of Robotic Surgery. 19. 10.1007/s11701-025-02535-7.

2. Harky et al. (2019). Robotic Cardiac Surgery: The Future Gold Standard or An Unnecessary Extravagance?. Brazilian Journal of Cardiovascular Surgery. 34. 10.21470/1678-9741-2019-0194.

3. Yang M et al. Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency. Ann Thorac Surg 2015;100:1367-73.

4. Halkos ME et al. Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery. J Thorac Cardiovasc Surg 2014;147:179-85.

5. Currie et al. (2012). Long-Term Angiographic Follow-Up of Robotic-Assisted Coronary Artery Revascularization. The Annals of thoracic surgery. 93. 1426-31. 10.1016/j.athoracsur.2011.11.031.

6. Hwang B, Ren J, Wang K, Williams ML, Yan TD. Systematic review and meta-analysis of two decades of reported outcomes for robotic coronary artery bypass grafting. Ann Cardiothorac Surg. 2024 Jul 31;13(4):311-325. doi: 10.21037/acs-2023-rcabg-0191. Epub 2024 Jul 26. PMID: 39157187; PMCID: PMC11327407.

ISMICS 2026 Annual Meeting

Comparative Analysis Of Graft Patency Of Robotic Vs Open Internal Mammary Artery Harvesting

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