Learning curve and clinical outcomes of robotic-assisted heart bypass surgery: Real-world evidence from India.

BackgroundRobotic-assisted coronary artery bypass grafting (CABG) using bilateral internal mammary arteries (BIMA) provides a minimally invasive option for advanced coronary artery disease (CAD), but evidence on its learning curve and outcomes in the Indian population remains limited.ObjectivesTo evaluate the learning curve associated with robotic CABG using BIMA and to compare perioperative and clinical outcomes between the early and late phases of surgical experience in a real-world setting.DesignRetrospective, single-center, observational chart review conducted at a high-volume quaternary cardiac care center in India.MethodsThis retrospective chart review was performed for 341 patients who underwent robotic-assisted BIMA CABG between 2020 and 2025. The learning curve was assessed using risk-adjusted cumulative summation (CUSUM), while complication trends were examined through sequential probability CUSUM failure analysis.ResultsThe cohort comprised 295 (86.51%) males with a mean age of 59.56 ± 9.93 years and a body mass index (BMI) of 25.98 ± 3.74 kg/m2. Mean console time was 101.66 ± 29.99 minutes, ICU stay 2.85 ± 0.98 days, and hospital stay 6.01 ± 2.38 days; conversion to open surgery occurred in 2.93% of cases, with in-hospital mortality of 3.52%. CUSUM analysis identified case 125 as the proficiency inflection point, after which console time significantly decreased (94.95 ± 24.32 vs. 113.38 ± 35.04 minutes; p<0.001), while ventilator duration, ICU and hospital stay, complications, and mortality remained comparable between phases. Readmission and re-exploration rates were low (2.05% each), with no deaths at 6-month follow-up. CUSUM failure analysis confirmed complication rates remained within acceptable thresholds throughout the study.ConclusionsRobotic-assisted BIMA CABG demonstrated acceptable outcomes, with operative efficiency improving after approximately 125 cases. These findings support its feasibility in experienced, high-volume centers and warrant further multicentre evaluation.