Operative outcomes following robotic-assisted and conventional minimally invasive mitral valve surgery: A meta-analysis of propensity-matched studies

Background Robotic-assisted mitral valve surgery (RAMVS) has emerged as an alternative to conventional minimally invasive mitral valve surgery (MIMVS). However, previous studies have been limited by small sample sizes, heterogeneous techniques and reliance on unmatched or indirectly compared cohorts, resulting in inconclusive evidence. This meta-analysis focuses exclusively on propensity-matched studies to provide a more robust comparison of RAMVS and MIMVS. Methods A comprehensive literature search was performed to identify propensity-matched studies comparing RAMVS and MIMVS. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using RevMan 8.13.0. Subgroup analyses, including mitral valve repair only, non-isolated mitral valve surgery and MIMVS via right minithoracotomy, were conducted to explore heterogeneity. Results Eight studies comprising 3352 patients were included, with 1578 (47.1%) undergoing RAMVS. The RAMVS was associated with a shorter hospital stay (MD −1.8 days; 95% CI −3.0 to −0.5; p = 0.006) but significantly longer cardiopulmonary bypass time (MD 21.8 min; 95% CI 0.8–42.9; p = 0.04), and higher odds of conversion to sternotomy (OR 2.9; 95% CI 1.6–5.4; p = 0.0007) and re-exploration for bleeding (OR 1.86; 95% CI 1.1–3.2; p = 0.02). Intensive care unit stay, operative time and postoperative complications were comparable. All subgroup analyses consistently showed higher conversion rates with RAMVS. Conclusion The RAMVS offers potential recovery benefits but at the cost of greater intraoperative complexity. Careful patient selection and technical expertise are essential to maximise outcomes.