Advantages and Limitations of the Use of Robots in Minimally Invasive Mitral Valve Repair: Results From a Matched Direct Comparison

Objective: To compare the surgical outcomes of nonrobotic and robotic minimally invasive mitral valve repair. Methods: We retrospectively reviewed patients who underwent minimally invasive mitral valve repair from January 2014 to March 2024. After excluding the learning curve cases, early and midterm outcomes were compared. Results: A total of 422 patients who underwent minimally invasive mitral valve repair (nonrobotic, n = 103; robotic, n = 319) were enrolled. The robotic group had a higher EuroSCORE II ( P < 0.001). After propensity matching, the final cohort included 84 and 168 patients in each group. In the robotic group after matching, concomitant procedures remained significantly more frequent ( P = 0.030). However, operative time ( P = 0.782) and cross-clamping time ( P = 0.452) were comparable, whereas cardiopulmonary bypass time was significantly longer in the robotic group ( P = 0.031). Postoperative blood transfusion ( P < 0.001), chest tube output within 24 h ( P < 0.001), and intensive care unit stay ( P = 0.042) remained higher in the robotic group after matching. Postoperative mitral regurgitation was no greater than mild in both groups ( P = 0.146). At 4 years, overall survival was 94.4% versus 98.4% ( P = 0.215), and freedom from recurrence of moderate or greater mitral regurgitation was 98.5% versus 97.9% ( P = 0.230) after matching. These results are consistent with those observed before matching. Conclusions: Robotic mitral valve repair demonstrated comparable perioperative and midterm outcomes despite greater transfusion requirements and a higher frequency of concomitant procedures. The higher rate of concomitant procedures should be interpreted with caution because it may partly reflect differences in surgical era and patient selection.