Mid-term outcomes of robotic assisted versus conventional sternotomy for mitral valve replacement: a nationwide propensity-weighted analysis using Taiwan’s National Health Insurance Research Database

Q: What are the key findings of this study?

Robotic-assisted mitral valve replacement was associated with significantly better survival (HR 0.37) and shorter hospital stays compared to conventional sternotomy.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Mitral valve disease requiring surgical replacement (n=5660). Intervention: Robotic-assisted mitral valve replacement (RAMVR) vs. Conventional sternotomy mitral valve replacement (CSMVR). Primary outcome: All-cause mortality (survival) (HR 0.37, 95% CI 0.33-0.41, p=<0.01).

Q: What does this research mean for the field?

Robotic-assisted mitral valve replacement is associated with significantly better mid-term survival, shorter hospital stays, and reduced medical costs compared to conventional sternotomy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yu-San Chien; Ching‐Hu Chung; Jiun-Yi Li

doi:10.1007/s11701-025-02564-2

July 16, 2025Journal of Robotic SurgeryOpen Access

Mid-term outcomes of robotic assisted versus conventional sternotomy for mitral valve replacement: a nationwide propensity-weighted analysis using Taiwan’s National Health Insurance Research Database

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Key result

Robotic mitral valve replacement is linked to ~63% lower mortality and shorter stays vs conventional sternotomy.

HR 0.37
95% CI 0.33-0.41
P<0.01
n=5,660

Why the study?

The study aimed to compare survival, complications, and healthcare costs between robotic-assisted and conventional sternotomy mitral valve replacement using a nationwide population-based dataset.

Does robotic-assisted mitral valve replacement improve survival and reduce complications compared to conventional sternotomy in patients undergoing isolated surgical mitral valve replacement?

Study Design

Type

Cohort (n=5,660)

Multicenter

Yes

Structured PICO

Does robotic-assisted mitral valve replacement improve survival and reduce complications compared to conventional sternotomy in patients undergoing isolated surgical mitral valve replacement?

P

Population

5,660 patients who underwent isolated surgical mitral valve replacement, analyzed using inverse probability of treatment weighting with up to 6 years of follow-up.

E

Exposure

Robotic-assisted mitral valve replacement (RAMVR)

C

Comparator

Conventional sternotomy mitral valve replacement (CSMVR)

O

Outcome

All-cause mortality (survival) over a maximum follow-up of 5 to 6 yearshard clinical

Main Result

Hazard Ratio: 0.37 (95% CI 0.33–0.41)

p-value: p=<0.01

Robotic-assisted mitral valve replacement is associated with improved mid-term survival, shorter hospital stays, and reduced post-discharge medical costs compared to conventional sternotomy.

Limitations

Lacks important clinical granularity such as baseline left ventricular ejection fraction, pulmonary hypertension, and NYHA functional class.
Operative details including cardiopulmonary bypass duration, aortic cross-clamp time, and transfusion volume were not captured.
Reliance on ICD-10 diagnosis and procedural codes may result in misclassification bias.
Maximum follow-up duration of five to six years may not be sufficient to assess long-term valve durability.
Cost analysis reflects only the portion reimbursed by Taiwan's NHI and does not account for out-of-pocket payments.
Rare complications had very low or zero event counts in the RAMVR group, reducing statistical power.
Lacks clinical granularity (missing baseline LVEF, pulmonary hypertension severity, and NYHA functional class)
Missing operative details (cardiopulmonary bypass duration, aortic cross-clamp time, transfusion volume)
Reliance on ICD-10 codes may introduce misclassification bias or coding errors
Maximum follow-up of 5-6 years may be insufficient to assess long-term valve durability
Cost analysis excludes out-of-pocket payments for robotic instruments and system usage
Low event counts for rare complications reduces statistical power
Temporal improvements in surgical technique and perioperative management may confound results

Implication

Should not yet change mitral valve replacement practice; leaves open whether robotic assistance improves survival in randomized trials.

Abstract

BACKGROUND: This study aimed to compare survival, complications, and healthcare costs between robotic-assisted and conventional sternotomy mitral valve replacement, using a nationwide population-based dataset from Taiwan. METHODS: Patients who underwent isolated surgical MVR between 2016 and 2021 were identified from Taiwan's National Health Insurance Research Database. A total of 5,736 patients met inclusion criteria: 5,547 underwent conventional sternotomy MVR (CSMVR), and 113 received robot-assisted MVR (RAMVR). To reduce confounding, inverse probability of treatment weighting (IPTW) was applied using age, sex, and Charlson Comorbidity Index as covariates, yielding a weighted cohort of 5,660 CSMVR and 5,640 RAMVR cases for outcome analysis. RESULTS: After IPTW adjustment, RAMVR was associated with significantly better survival (hazard ratio: 0.37; 95% confidence interval: 0.33-0.41; p < 0.01), shorter hospital stay (16.5 vs. 22.7 days, p < 0.01), and shorter intensive care unit stay (4.4 vs. 9.1 days, p < 0.01). RAMVR patients also had lower rates of dialysis and stroke. One-year post-discharge medical costs were significantly lower in the RAMVR group (USD 1,640 vs. 4,003, p < 0.01). Although inpatient costs appeared lower for RAMVR, this reflects the exclusion of patient-borne expenses for robotic equipment not reimbursed by insurance. CONCLUSION: In this national population-based analysis, RAMVR was associated with better mid-term survival, shorter hospital stays, and reduced medical costs compared with conventional sternotomy. These findings support the use of robotic-assisted surgery as a safe and effective alternative in selected patients undergoing mitral valve replacement.

Discussion

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Figures from the paper

Published by Journal of Robotic Surgery · CC BY-NC-ND

Cite This Study

Chien et al. (2025) conducted a cohort in Mitral valve disease requiring surgical replacement (n=5,660). Robotic-assisted mitral valve replacement (RAMVR) vs. Conventional sternotomy mitral valve replacement (CSMVR) was evaluated on All-cause mortality (survival) (HR 0.37, 95% CI 0.33-0.41, p=<0.01). Robotic-assisted mitral valve replacement was associated with significantly better survival (HR 0.37) and shorter hospital stays compared to conventional sternotomy.

synapsesocial.com/papers/6a1eafd1544bdf605faf2a41 https://doi.org/10.1007/s11701-025-02564-2

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Mid-term outcomes of robotic assisted versus conventional sternotomy for mitral valve replacement: a nationwide propensity-weighted analysis using Taiwan’s National Health Insurance Research Database

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Mid-term outcomes of robotic assisted versus conventional sternotomy for mitral valve replacement: a nationwide propensity-weighted analysis using Taiwan’s National Health Insurance Research Database

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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