Key result
Robotic mitral valve plasty had shorter operation times but higher adjusted hospital costs ($35,674 vs $18,208, P<0.001) and blood transfusion rates than the thoracoscopic approach.
Why the study?
To compare the clinical outcomes and hospital cost between robotic and thoracoscopic approaches to mitral valve plasty.
Does robotic mitral valve plasty improve clinical outcomes and reduce hospital costs compared to thoracoscopic mitral valve plasty in patients requiring minimally invasive MVP?
Cohort (n=234)
No
Does robotic mitral valve plasty improve clinical outcomes and reduce hospital costs compared to thoracoscopic mitral valve plasty in patients requiring minimally invasive MVP?
Absolute Event Rate: 35674.3% vs 18208.4%
p-value: p=<0.001
Both robotic and thoracoscopic approaches for mitral valve plasty are safe, but thoracoscopic MVP offers lower hospital costs and reduced ICU time, whereas robotic MVP provides shorter operative times.
May favor thoracoscopic approach to limit costs and transfusions; leaves open robotic benefits in randomized trials.
Background: To compare the clinical outcomes and hospital cost of robotic versus thoracoscopic approaches to mitral valve plasty (MVP). Methods: We retrospectively analyzed patients who received minimal invasive MVP between 2007 January and 2020 January at our department. The basic characteristics, echocardiography, surgical data, postoperative adverse events and hospital cost of the patients were collected. The primary outcomes of this study were direct hospital cost and 30-day outcomes, including the operative time, complications, and length of hospital stay. Results: A total of 234 patients received minimally invasive MVP by using robotic (n=121) and thoracoscopic (n=113) technique respectively. The overall 30-day mortality rate was 0.9% (n=2), with no significant difference between two groups. The cardiopulmonary bypass time and aorta clamping time in thoracoscopic group were longer than that in robotic group (153.2±25.6 vs . 123.8±34.9 min and 111.8±23.0 vs . 84.9±24.3 min, P<0.001). The intraoperative blood transfusion rate (52.2% vs . 64.5%) and ICU time (2.8±2.3 vs . 3.6±2.7 days, all P<0.05) of the thoracoscopic group were lower than those in the robotic group. The adjusted hospital and operating room cost of the thoracoscopic group were significant lower ($18,208.4±$4,429.1 vs . $35,674.3±$4,936.1 and $9,038.3±$2,171.7 vs . $18,655.1±$2,558.3, all P<0.001). Conclusions: Both robotic and thoracoscopic approach for MVP are safe and reliable. Robotic technique has shorter operation time, while thoracoscopic technique has more advantages in blood transfusion rate, postoperative ventilation time, ICU duration and hospitalization expenses.
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Wei et al. (2020) conducted a cohort in Mitral valve disease requiring plasty (n=234). Robotic mitral valve plasty vs. Thoracoscopic mitral valve plasty was evaluated on Adjusted hospital cost (p=<0.001). Robotic mitral valve plasty had shorter operation times but higher adjusted hospital costs ($35,674 vs $18,208, P<0.001) and blood transfusion rates than the thoracoscopic approach.
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