Key result
Thoracic deformity does not prolong cross-clamp time or worsen outcomes in robotic mitral repair.
Why the study?
Robotic MVr potentially overcomes challenges in severe thoracic deformity, but surgical outcomes and the impact on operative times required evaluation.
Does robotic mitral valve repair provide comparable surgical outcomes and operative times in patients with thoracic deformity compared to those without?
Cohort (n=359)
No
Does robotic mitral valve repair provide comparable surgical outcomes and operative times in patients with thoracic deformity compared to those without?
Absolute Event Rate: 80% vs 80%
p-value: p=0.969
Robotic mitral valve repair is safe and effective in patients with severe thoracic deformity, yielding comparable operative times and clinical outcomes to patients without deformity.
Robotic mitral valve repair may remain feasible with thoracic deformity; extends observational experience but leaves open need for randomized confirmation.
Background: Robotic mitral valve repair (MVr) offers superior visualization and dexterity, potentially overcoming challenges in severe thoracic deformity such as pectus excavatum. This study compared surgical outcomes after MVr in patients with and without thoracic deformity and assessed the impact of thoracic deformity on operative times in robotic MVr. Methods and Results: We reviewed 359 patients undergoing robotic MVr for degenerative mitral regurgitation (2018-2022). Patients with a Haller index ≥3.25 categorized as the deformity group (Group D; n=35), and those with a Haller index <3.25 were in the non-deformity group (Group N; n=324). Group D was younger, but repair techniques and concomitant surgery were similar. In the results, there was no significant difference in operative time and aortic cross-clamp time (80±29 vs. 80±30 min; P=0.969) between the 2 groups. No correlation was found between thoracic dimensions and cross-clamp time. Early outcomes, including intensive care unit stay (1.92±1.59 vs. 1.77±1.26 days; P=0.519), hospital stay, mortality, stroke, and re-exploration, were comparable. Perioperative redo occurred in 4 patients in Group N (hemolysis from regurgitant jet, residual P2 prolapse, suture dehiscence) and 2 patients in Group D (systolic anterior motion-induced mitral regurgitation, poor posterior leaflet coaptation). One-year mitral regurgitation grade, survival, and freedom from reoperation were similar. Conclusions: Among patients with thoracic deformity deemed suitable for robotic MVr, outcomes were not worse compared with patients without deformity.
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Tomita et al. (2026) conducted a cohort in Degenerative mitral regurgitation (n=359). Thoracic deformity (Haller index ≥3.25) vs. No thoracic deformity (Haller index <3.25) was evaluated on Aortic cross-clamp time (p=0.969). Thoracic deformity did not significantly prolong aortic cross-clamp time (80 vs. 80 min) or worsen early and 1-year surgical outcomes in patients undergoing robotic mitral valve repair.
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