Robotic mitral repair yielded similar 5-year rates of death or mitral reintervention compared to non-robotic repair (17.8% vs. 18.6%; HR 0.93; 95% CI 0.79-1.09; p=0.37).
Cohort (n=26,524)
Yes
Does robotic mitral repair reduce death or mitral reintervention compared to non-robotic mitral repair in patients undergoing isolated first-time non-emergent mitral repair?
Robotic mitral repair is safe and yields comparable 5-year outcomes to non-robotic repair, with the added benefits of shorter hospital stays and lower postoperative atrial fibrillation.
Effect estimate: HR 0.93 (95% CI 0.79-1.09)
Absolute Event Rate: 17.8% vs 18.6%
p-value: p=0.37
BACKGROUND High-volume centers report acceptable outcomes for robotic mitral repair, yet population level data are limited. We compared late mortality and re-intervention rates for robotic versus non-robotic mitral repair in the United States. METHODS The Centers for Medicare and Medicaid database validated against clinical records was used to identify 26,524 isolated first-time non-emergent mitral ± tricuspid repairs or ablations without other concomitant procedures. Of these, 2,227 (8.3%) underwent robotic repair and 24,297 (91.7%) non-robotic repair. Propensity score matching was performed on 30 baseline characteristics. The primary endpoint was a composite of death or mitral reintervention, and the secondary endpoint was all-cause mortality. Both were compared in a Cox proportional hazards model. Falsification endpoint analysis assessed for potential unmeasured confounders with death as a competing risk. RESULTS Matching yielded 2,226 patient pairs (mean age 72 years; 44% female; 9% with concomitant tricuspid repair; 7% ablation). Thirty-day mortality did not differ between groups (1.3% robotic vs. 1.3% non-robotic, p=0.90). Robotic repair was associated with lower postoperative atrial fibrillation (19.1% vs. 23.2%, p=0.001) and a shorter hospital stay (median 5 days IQR 4-7 vs. 7 days IQR 5-9, p<0.001). At 5 years, the composite of death or mitral reintervention (17.8% vs.18.6%, HR: 0.93, 95%CI: 0.79-1.09, p=0.37) and all-cause mortality (14.9% vs.15.6%, HR: 0.93, 95%CI: 0.77-1.11, p=0.40) were similar, with falsification testing confirming minimal confounding (p=0.20). CONCLUSIONS Robotic mitral repair in the United States is safe, yielding outcomes comparable to those of non-robotic repair.
Tam et al. (Sun,) conducted a cohort in Isolated first-time non-emergent mitral repair (n=26,524). Robotic mitral repair vs. Non-robotic mitral repair was evaluated on Composite of death or mitral reintervention (HR 0.93, 95% CI 0.79-1.09, p=0.37). Robotic mitral repair yielded similar 5-year rates of death or mitral reintervention compared to non-robotic repair (17.8% vs. 18.6%; HR 0.93; 95% CI 0.79-1.09; p=0.37).