Key result
Robotic mitral valve repair shows comparable perioperative mortality to thoracoscopic repair but lowers AF risk.
Why the study?
Robotic and thoracoscopic minimally invasive mitral valve repair have emerged as alternatives to open-heart surgery, but their comparative effectiveness and safety remain underexplored.
Does robotic minimally invasive mitral valve repair improve perioperative outcomes compared to thoracoscopic repair in patients with mitral regurgitation?
Meta-Analysis (n=11,823)
Does robotic minimally invasive mitral valve repair improve perioperative outcomes compared to thoracoscopic repair in patients with mitral regurgitation?
Relative Risk: 0.97 (95% CI 0.65–1.45)
Robotic and thoracoscopic minimally invasive mitral valve repair offer comparable perioperative mortality, though robotic surgery is associated with longer operative times and higher transfusion needs but a lower risk of atrial fibrillation.
Robotic and thoracoscopic MIMR show comparable mortality and safety; extends matched data while highlighting trade-offs that require randomized confirmation.
Mitral regurgitation is the most prevalent form of valvular heart disease, impacting over 24 million people globally. Robotic and thoracoscopic minimally invasive mitral valve repair (MIMR) techniques have emerged as viable alternatives to traditional open-heart surgery. However, the comparative effectiveness and safety of these 2 approaches remain underexplored. This systematic review and meta-analysis, conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, aimed to compare robotic and thoracoscopic MIMR outcomes. A literature search was performed across PubMed, Scopus, and Embase databases to identify studies comparing these 2 surgical techniques. Eligible studies included randomized controlled trials and cohort studies. Six propensity score-matched studies and 1 retrospective cohort study, involving 11,823 patients, were included, with 5851 undergoing robotic mitral valve repair and 5972 receiving thoracoscopic MIMR. No significant differences were found in perioperative mortality [risk ratio (RR): 0.97, 95% confidence interval (CI): 0.65-1.45] or pump/clamp times. Robotic surgery was associated with longer operative times (mean difference: 33.01 minutes) and higher intraoperative transfusion rates (RR: 1.53, 95% CI: 1.07-2.18), but a lower risk of atrial fibrillation (RR: 0.89, 95% CI: 0.83-0.95). In conclusion, robotic and thoracoscopic MIMR show comparable mortality and overall safety profiles. However, robotic surgery may require longer operative times and increased transfusion needs, while reducing the risk of atrial fibrillation. Further high-quality, randomized studies are warranted to validate these findings.
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Jesse et al. (2024) conducted a meta-analysis in Mitral regurgitation (n=11,823). Robotic minimally invasive mitral valve repair vs. Thoracoscopic minimally invasive mitral valve repair was evaluated on Perioperative mortality (RR 0.97, 95% CI 0.65-1.45). Robotic minimally invasive mitral valve repair showed comparable perioperative mortality to thoracoscopic repair (RR 0.97; 95% CI 0.65-1.45), with longer operative times but lower atrial fibrillation risk.
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