Robotic‐Assisted vs. Mini Thoracotomy Mitral Valve Repair for Myxomatous Mitral Valve Disease

Objective Minimally invasive techniques represent an emerging standard of care for the surgical treatment of myxomatous mitral valve disease. Due to the limited availability of the daVinci surgical system at our center, a robotic‐assisted (RA) approach is generally reserved for patients with complex leaflet pathology. Consequently, in order to accurately evaluate any possible outcome difference between the minimally invasive right thoracotomy and RA surgical approach, we selected patients with myxomatous mitral valve disease for evaluation. Methods From 2012 to 2021, 300 patients with degenerative mitral valve disease and myxomatous pathology underwent isolated mitral repair surgery through either a mini‐thoracotomy (MT) (229 patients) or a RA (71 patients) approach. Propensity score matching yielded 71 patients in each group for which outcomes were evaluated. Results After propensity score matching, there was no difference between groups with respect to the preoperative baseline characteristics. There was no difference in cross‐clamp time between the two groups. The RA patients were more likely to receive a partial annuloplasty band, a titanium knot fastener, and a triangular resection compared to the MT group. Residual mitral regurgitation greater than mild was similar between groups (RA = 1.4%, MT = 0%, NS). There was no difference in the postoperative outcomes between groups. Conclusions Based on our experience, both RA and MT surgical approaches yield excellent results for patients with myxomatous mitral valve disease. While there were differences in mitral repair technique between the two groups, there was no significant difference in outcomes. Expansion of this evidence base through prospective and multicenter studies may be warranted. Central Message In our single institution experience, both RA and MT mitral valve repair yield excellent results for patients with myxomatous mitral valve disease.