Methods: All coronary artery bypass grafting (CABG) patients who underwent robotic assisted minimally invasive off-pump coronary surgery at our institution between July 2019 and June 2022 were evaluated. Data were collected prospectively. Surgical technique: both internal mammary arteries were harvested using the DaVinci system (Intuitive®). T-graft as well as distal coronary anastomoses were performed through a left sided mini-thoracotomy (4 – 8 cm) guided by the DaVinci.

Results: A total of 150 patients were included, 88 received robotic assisted MIDCAB and 62 MICS-CABG. Mean age was 66 ± 11.7 years and mean EuroSCORE II was 1.9 ± 2.1. In the first year there were 8 conversions to sternotomy, in the second year one to sternotomy and one to sternotomy and ECC. Forty-two cases were planned hybrid procedures. There were three deaths in the first 30-days, two due to covid pneumonia and one due to cardiogenic shock as consequence of bypass occlusion. The rate of postoperative complications was very low; the most prevalent was new onset atrial fibrillation with 17.3%. Mean intensive care and hospital stay were 1.2 and 6.3 days, respectively.

Conclusion: Robotic assisted minimally invasive CABG is associated with excellent early outcomes, even during the establishment phase.