Outcomes of Robotic Approach Versus Resternotomy in Redo Mitral Valve Surgery: A Propensity‐Matched Study

Objective A robotic approach to primary structural cardiac operations has been established, but there are fewer reports regarding its use in a reoperative setting. Our primary aim was to retrospectively compare outcomes between patients who underwent a robotic approach versus resternotomy for reoperative mitral valve interventions. Methods A retrospective propensity‐score matched observational study was performed at one large volume referral center with an advanced robotic cardiac surgery program from 2019 to 2024. Adults who had prior sternotomy for cardiac operations and were undergoing mitral valve surgery were included. Propensity scores were calculated using 14 preoperative clinical variables. An optimal algorithm was used to generate pairs in a 1:2 fashion between patients who underwent robotic approach or resternotomy. Continuous and categorical variables were compared using the Wilcoxon two‐sample test and chi‐square or Fisher’s exact test, respectively. Results 172 patients met the inclusion criteria, with 137 patients in the resternotomy group and 35 patients in the robotic approach group. 1:2 matching resulted in 35 patients in the robot approach and 70 patients in the resternotomy group. Preoperative demographics and clinical characteristics were well matched between the groups. The robotic approach was associated with higher cardiopulmonary bypass times. There was no significant difference in total transfusion requirements, ICU or postoperative length of stay, or in‐hospital mortality. Conclusions Our observational study suggests that in experienced hands, a robotic approach to mitral valve operations in a reoperative field can provide noninferior outcomes to resternotomy. Patient selection and surgeon experience are critical to achieving these outcomes.