Key result
Totally endoscopic robotic mitral valve replacement resulted in a non-significant reduction in long-term major adverse cardiac and cerebrovascular events compared to conventional sternotomy (6.4% vs 36.2%, OR 5.7, P=0.10), while significantly reducing ICU and hospital stays.
Why the study?
Robot-assisted mitral valve surgery is increasingly used, but evidence was needed to assess the safety, effectiveness, and follow-up outcomes of totally endoscopic robotic mitral valve replacement as a surgical choice.
Does totally endoscopic robotic mitral valve replacement improve clinical outcomes and safety compared to conventional sternotomy in patients requiring mitral valve replacement?
Cohort (n=94)
No
Does totally endoscopic robotic mitral valve replacement improve clinical outcomes and safety compared to conventional sternotomy in patients requiring mitral valve replacement?
Odds Ratio: 5.7
Absolute Event Rate: 6.4% vs 36.2%
p-value: p=0.10
Robotic mitral valve replacement is a feasible and safe minimally invasive alternative to sternotomy, offering comparable long-term survival and potentially fewer perioperative complications despite longer operative times.
May shorten ICU/hospital stays without excess long-term events; leaves open superiority versus sternotomy in randomized trials.
BackgroundRobot-assisted mitral valve surgery has been increasingly used by surgeons to achieve better results. This study was to assess the safety and effectiveness of totally endoscopic robotic mitral valve replacement (TE-MVR) and to provide evidence that it is a reasonable surgical choice by analyzing the clinical experience, surgical efficacy, and follow-up outcomes of this procedure.MethodBetween October 2008 and October 2015, 47 patients underwent da Vinci TE-MVR. From March 2002 to June 2014, 293 patients underwent conventional sternotomy mitral valve replacement (CS-MVR), of whom 47 patients were selected to match the TE-MVR group (1:1). We performed a retrospective study by collecting perioperative data and assessed TE-MVR efficacy by comparing clinical outcomes and echocardiography with CS-MVR in a 10-year follow-up period.ResultsAll cases were conducted successfully. No operative deaths were observed, and the complications were not significantly different between the groups. The cardiopulmonary bypass time (122.02±25.45 min) and aortic cross-clamping time (85.68±20.70 min) were longer in TE-MVR group (P<0.001). The perioperative complications are similar in two groups, but the drainage volume, blood product transfusion, ICU stay and postsurgical hospital stay are better in robotic group (P<0.001). During the follow-up period, 42 patients (89.4%) in TE-MVR group and 40 patients (87.0%) in CS-MVR group were followed. Long-term event-free survival is similar in both groups. ConclusionRobotic MVR is a feasible, effective and safe minimally-invasive alternative to sternotomy MVR, and the long-term clinical and echocardiographic results are comparable to sternotomy MVR in selected patients.
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Zhao et al. (2020) conducted a cohort in Mitral valve disease requiring replacement (n=94). Totally endoscopic robotic mitral valve replacement vs. Conventional sternotomy mitral valve replacement was evaluated on Cumulative major adverse cardiac and cerebrovascular events (MACCE) (OR 5.7, p=0.10). Totally endoscopic robotic mitral valve replacement resulted in a non-significant reduction in long-term major adverse cardiac and cerebrovascular events compared to conventional sternotomy (6.4% vs 36.2%, OR 5.7, P=0.10), while significantly reducing ICU and hospital stays.
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