Key result
Mini-MVR compared to robotic MVR was associated with lower costs and neurologic events (1.32% vs 2.37%; P=0.02), but a trend toward higher 30-day mortality (1.24% vs 0.55%; OR 2.27, P=0.052).
Why the study?
Does robotic MVR compared to mini-MVR improve clinical outcomes and cost-effectiveness in patients undergoing mitral valve surgery?
Meta-Analysis
Yes
Does robotic MVR compared to mini-MVR improve clinical outcomes and cost-effectiveness in patients undergoing mitral valve surgery?
Odds Ratio: 2.27
Absolute Event Rate: 1.24% vs 0.55%
p-value: p=0.052
Robotic mitral valve surgery is associated with higher costs and increased rates of neurologic events, postoperative atrial fibrillation, and conversion to conventional surgery compared to nonrobotic minimally invasive approaches.
Robotic MVR may increase neurologic events and costs versus mini-MVR; leaves open mortality trade-offs pending randomized data.
OBJECTIVE: To date, a direct comparison of minimally invasive mitral valve repair or replacement (mini-MVR) versus robotic MVR is lacking; therefore, the purpose of this study was to address this deficit and compare mini-MVR with robotic MVR from a cost-benefit perspective. METHODS: From a total of 759 literature citations, 21 studies were included for statistical comparisons of benefit outcomes, whereas 3 studies and our institutional experience were used to compare costs. RESULTS: The total cost per case exceeding that of conventional MVR is approximately $2063.90 for robotic MVR and $271 for mini-MVR. Mean 30-day mortality rates for mini-MVR and robotic MVR groups were 1.24% and 0.55%, respectively [106/8548 vs 6/1089; odds ratio (OR), 2.27; P = 0.052]. The conversion rate to conventional MVR was 0.77% in mini-MVR and 1.83% in robotic MVR (35/5092 vs 22/1046; OR, 0.32; P < 0.001). The rate of neurologic events was 1.32% in mini-MVR and 2.37% in robotic MVR (109/8257 vs 20/845; OR, 0.55; P = 0.02). Postoperative atrial fibrillation was seen in 11.42% of mini-MVR patients and in 19.67% of robotic MVR patients (371/3249 vs 203/1032; OR, 0.53, P < 0.001). Mean cardiopulmonary bypass time was longer in mini-MVR (137.4 vs 130.4 minutes), whereas cross-clamp time was shorter (82.2 vs 96.7 minutes). CONCLUSIONS: Our comparative analysis provides insights into the clinical benefits versus variable costs relationship related to mini-MVR and robotic MVR.
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Hassan et al. (2015) conducted a meta-analysis in Mitral valve disease requiring surgery. Minimally invasive mitral valve repair or replacement (mini-MVR) vs. Robotic MVR was evaluated on 30-day mortality (OR 2.27, p=0.052). Mini-MVR compared to robotic MVR was associated with lower costs and neurologic events (1.32% vs 2.37%; P=0.02), but a trend toward higher 30-day mortality (1.24% vs 0.55%; OR 2.27, P=0.052).
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