EP 492 Outcomes in Robotic Redo Cardiac Surgery: A Novel Systematic Review and Meta-Analysis

Aims Redo cardiac surgery via resternotomy is technically challenging due to pericardial adhesions. Robotic techniques offer a minimally invasive alternative but pooled outcomes are limited. This review evaluates clinical outcomes of robotic redo cardiac surgery, focusing on mitral valve reinterventions. Methods A PRISMA-compliant systematic review was performed across PubMed, Scopus, Embase, MEDLINE and Web of Science. Meta-analyses focused on the robotic redo mitral surgery subgroup. Primary outcomes included in-hospital mortality (IHM), cardiopulmonary bypass (CPB) time and in-hospital length of stay (LOS). IHM was pooled using Freeman-Tukey double arcsine transformation. CBP time and LOS were analysed using DerSimonian-Laird random-effects models. Outcomes for tricuspid surgery and coronary artery bypass grafting (CABG) were assessed qualitatively. Results Eight studies met the inclusion criteria. In the mitral subgroup, pooled IHM was 2% (95% CI: 0-4.1%), with high consistency across cohorts (I2 = 0%, p = 0.95). Pooled mean CPB time was 149.2 minutes (95% CI: 113.1-185.3) and LOS was 7.4 days (95% CI: 5.07-9.73), both with high heterogeneity, in studies that reported these outcomes. Comparative data from one study suggested lower mortality in robotic redo mitral surgery compared to resternotomy. Qualitative synthesis of tricuspid and CABG cases demonstrated low mortality. Conclusions Robotic redo mitral valve surgery is a safe, reproducible alternative to resternotomy. While outcomes for tricuspid and CABG procedures are promising, the evidence base remains primarily centred on mitral interventions. Future multi-centre prospective registries and large-scale comparative trials are required to definitively establish the long-term clinical and economic benefits of robotic redo cardiac surgery.