Robotic vs. minimally invasive mitral valve repair: A 5-year comparison of surgical outcomes.
valve repair/replacement
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
revised:
15
06
2022
received:
18
04
2022
accepted:
02
07
2022
pubmed:
23
8
2022
medline:
8
9
2022
entrez:
22
8
2022
Statut:
ppublish
Résumé
Minimally invasive mitral valve repair (MVr) is commonly performed. Data on the outcomes of robotic MVr versus nonrobotic minimally invasive MVr are lacking. We sought to compare the short-term and mid-term outcomes of robotic and nonrobotic MVr. We reviewed all patients who underwent robotic MVr (n = 424) or nonrobotic MVr via right mini-thoracotomy (n = 86) at Mayo Clinic, Rochester, MN, from January 2015 to February 2020. Data on baseline and operative characteristics, operative and long-term outcomes were analyzed. Patients were matched 1:1 using propensity scores. Sixty-nine matched pairs were included in the study. The median age was 59 years (interquartile range [IQR]: 54-69) and 75% (n = 103) were male. Baseline characteristics were similar after matching. Robotic and nonrobotic MVr had similar operative characteristics, except that robotic had longer cross-clamp times (57 [48-67] vs. 47 [37-58] min, p < .001) and more P2 resections (83% vs. 68%, p = .05) compared to nonrobotic MVr. There was no difference in operative outcomes between groups. Hospital stay was shorter after robotic MVr (4 [3-4] vs. 4 [4-6] days, p = .003). After a median follow-up of 3.3 years (IQR, 2.1-4.5), there was no mortality in either group, and there was no difference in freedom from mitral valve reoperations between robotic and nonrobotic MVr (5 years: 97.1% vs. 95.7%, p = .63). Follow-up echocardiogram analysis predicted excellent freedom from recurrent moderate-or-severe mitral regurgitation at 3 years after robotic and nonrobotic MVr (90% vs. 92%, p = .18, respectively). Both short-term and mid-term outcomes of robotic and nonrobotic minimally invasive mitral repair surgery are comparable.
Sections du résumé
BACKGROUND
BACKGROUND
Minimally invasive mitral valve repair (MVr) is commonly performed. Data on the outcomes of robotic MVr versus nonrobotic minimally invasive MVr are lacking. We sought to compare the short-term and mid-term outcomes of robotic and nonrobotic MVr.
METHODS
METHODS
We reviewed all patients who underwent robotic MVr (n = 424) or nonrobotic MVr via right mini-thoracotomy (n = 86) at Mayo Clinic, Rochester, MN, from January 2015 to February 2020. Data on baseline and operative characteristics, operative and long-term outcomes were analyzed. Patients were matched 1:1 using propensity scores.
RESULTS
RESULTS
Sixty-nine matched pairs were included in the study. The median age was 59 years (interquartile range [IQR]: 54-69) and 75% (n = 103) were male. Baseline characteristics were similar after matching. Robotic and nonrobotic MVr had similar operative characteristics, except that robotic had longer cross-clamp times (57 [48-67] vs. 47 [37-58] min, p < .001) and more P2 resections (83% vs. 68%, p = .05) compared to nonrobotic MVr. There was no difference in operative outcomes between groups. Hospital stay was shorter after robotic MVr (4 [3-4] vs. 4 [4-6] days, p = .003). After a median follow-up of 3.3 years (IQR, 2.1-4.5), there was no mortality in either group, and there was no difference in freedom from mitral valve reoperations between robotic and nonrobotic MVr (5 years: 97.1% vs. 95.7%, p = .63). Follow-up echocardiogram analysis predicted excellent freedom from recurrent moderate-or-severe mitral regurgitation at 3 years after robotic and nonrobotic MVr (90% vs. 92%, p = .18, respectively).
CONCLUSIONS
CONCLUSIONS
Both short-term and mid-term outcomes of robotic and nonrobotic minimally invasive mitral repair surgery are comparable.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3267-3275Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2021;143(5):72. doi:10.1161/cir.0000000000000923
David TE, David CM, Tsang W, Lafreniere-Roula M, Manlhiot C. Long-term results of mitral valve repair for regurgitation due to leaflet prolapse. J Am Coll Cardiol. 2019;74(8):1044-1053. doi:10.1016/j.jacc.2019.06.052
Lazam S, Vanoverschelde J-L, Tribouilloy C, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation. Circulation. 2017;135(5):410-422. doi:10.1161/circulationaha.116.023340
Karagoz HY, Bayazit K, Battaloglu B, et al. Minimally invasive mitral valve surgery: the subxiphoid approach. Ann Thorac Surg. 1999;67(5):1328-1332. doi:10.1016/s0003-4975(99)00059-4
Mishra YK, Malhotra R, Mehta Y, Sharma KK, Kasliwal RR, Trehan N. Minimally invasive mitral valve surgery through right anterolateral minithoracotomy. Ann Thorac Surg. 1999;68(4):1520-1524. doi:10.1016/s0003-4975(99)00963-7
Casselman FP, Slycke SV, Dom H, Lambrechts DL, Vermeulen Y, Vanermen H. Endoscopic mitral valve repair: feasible, reproducible, and durable. J Thorac Cardiovasc Surg. 2003;125(2):273-282. doi:10.1067/mtc.2003.19
Grossi EA, Galloway AC, LaPietra A, et al. Minimally invasive mitral valve surgery: a 6-year experience with 714 patients. Ann Thorac Surg. 2002;74(3):660-664. doi:10.1016/s0003-4975(02)03754-2
Iribarne A, Russo MJ, Easterwood R, et al. Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis. Ann Thorac Surg. 2010;90(5):1471-1478. doi:10.1016/j.athoracsur.2010.06.034
Mohr FW, Falk V, Diegeler A, et al. Computer-enhanced “robotic” cardiac surgery: experience in 148 patients. J Thorac Cardiovasc Surg. 2001;121(5):842-853. doi:10.1067/mtc.2001.112625
Mihaljevic T, Jarrett CM, Gillinov AM, et al. Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized. J Thorac Cardiovasc Surg. 2011;141(1):72-80. doi:10.1016/j.jtcvs.2010.09.008
Wang A, Brennan JM, Zhang S, et al. Robotic mitral valve repair in older individuals: an analysis of the society of thoracic surgeons database. Ann Thorac Surg. 2018;106(5):1388-1393. doi:10.1016/j.athoracsur.2018.05.074
Woo YJ, Nacke EA. Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay. Surgery. 2006;140(2):263-267. doi:10.1016/j.surg.2006.05.003
Wei S, Zhang X, Cui H, et al. Comparison of clinical outcomes between robotic and thoracoscopic mitral valve repair. Cardiovasc Diagn Ther. 2020;10(5):1167-1174. doi:10.21037/cdt-20-197
Barac YD, Loungani RS, Sabulsky R, et al. Robotic versus port-access mitral repair: a propensity score analysis. J Cardiac Surg. 2021;36(4):1219-1225. doi:10.1111/jocs.15342
Suri RM, Schaff HV, Meyer SR, Hargrove WC. Thoracoscopic versus open mitral valve repair: a propensity score analysis of early outcomes. Ann Thorac Surg. 2009;88(4):1185-1190. doi:10.1016/j.athoracsur.2009.04.076
Arghami A, Jahanian S, Daly RC, et al. Robotic mitral valve repair: a decade of experience with echocardiographic follow-up. Ann Thorac Surg. Published online November 18, 2021. doi:10.1016/j.athoracsur.2021.08.083
McClure RS, Athanasopoulos LV, McGurk S, Davidson MJ, Couper GS, Cohn LH. One thousand minimally invasive mitral valve operations: early outcomes, late outcomes, and echocardiographic follow-up. J Thorac Cardiovasc Surg. 2013;145(5):1199-1206. doi:10.1016/j.jtcvs.2012.12.070
Chitwood WR Jr, Rodriguez E, Chu MW, et al. Robotic mitral valve repairs in 300 patients: a single-center experience. J Thorac Cardiovasc Surg. 2008;136(2):436-441. doi:10.1016/j.jtcvs.2008.03.053
Yoo JS, Kim JB, Jung S-H, et al. Mitral durability after robotic mitral valve repair: analysis of 200 consecutive mitral regurgitation repairs. J Thorac Cardiovasc Surg. 2014;148(6):2773-2779. doi:10.1016/j.jtcvs.2014.07.054
Svensson LG, Atik FA, Cosgrove DM, et al. Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2010;139(4):926-932. doi:10.1016/j.jtcvs.2009.09.038
Cheng DC, Martin J, Lal A, et al. Minimally invasive versus conventional open mitral valve surgery a meta-analysis and systematic review. Innovations. 2011;6(2):84-103. doi:10.1177/155698451100600204
Sündermann SH, Sromicki J, Rodriguez Cetina Biefer H, et al. Mitral valve surgery; right lateral minithoracotomy or sternotomy? A systematic review and meta-analysis. Thorac Cardiovasc Surg. 2014;62(S 01):1989-1995. doi:10.1055/s-0034-1367411