{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T13:34:38Z","timestamp":1793021678767,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Cardiovascular Disease"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Robotic-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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective, single-center, observational chart review conducted at a high-volume quaternary cardiac care center in India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 295 (86.51%) males with a mean age of 59.56 \u00b1 9.93 years and a body mass index (BMI) of 25.98 \u00b1 3.74 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Mean console time was 101.66 \u00b1 29.99 minutes, ICU stay 2.85 \u00b1 0.98 days, and hospital stay 6.01 \u00b1 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 \u00b1 24.32 vs. 113.38 \u00b1 35.04 minutes; p&lt;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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Robotic-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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17539447261497156","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:11:01Z","timestamp":1792793461000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Learning curve and clinical outcomes of robotic-assisted heart bypass surgery: Real-world evidence from India"],"prefix":"10.1177","volume":"20","author":[{"given":"M. M.","family":"Yusuf","sequence":"first","affiliation":[{"name":"Apollo Hospitals"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganapathy Arumugam","family":"Chandrasekharan","sequence":"additional","affiliation":[{"name":"Apollo Hospitals"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Bansal","sequence":"additional","affiliation":[{"name":"Indraprastha Apollo Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pula Ravi","family":"Teja","sequence":"additional","affiliation":[{"name":"Apollo Hospitals"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8305-7744","authenticated-orcid":false,"given":"Aishwarya","family":"Mahesh Kumar","sequence":"additional","affiliation":[{"name":"Clinical Administration, Apollo Hospitals, Corporate Office"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005346"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30407-8"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.02.43"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12055-023-01514-7"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.08.033"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.21037\/acs-2024-rcabg-0016"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.14459"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.optechstcvs.2010.08.002"},{"key":"e_1_3_8_10_2","volume-title":"StatPearls. 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