Outcomes of Robotic Mitral Valve Repair for Degenerative Mitral Valve Regurgitation in Patients Aged ≥80 Years　― Its Role in the Era of Expanding Transcatheter Edge-to-Edge Repair ―

Background: Transcatheter edge-to-edge repair (TEER) has increasingly been used for elderly patients with degenerative mitral regurgitation (DMR), while minimally invasive surgical approaches such as robotic mitral valve repair (RMVr) may offer durable repair with reduced invasiveness. We evaluated the safety and durability of RMVr in octogenarians with DMR and assessed its role in contemporary treatment strategies by comparison with younger patients as a reference cohort. Methods and Results: We retrospectively analyzed 412 patients who underwent RMVr for DMR from 2018 to 2025. Patients were divided into an elderly group (E; age ≥80 years; n=42) and a younger group (Y; age <80 years; n=370). Octogenarians had higher operative risk with more atrial fibrillation, heart failure, pulmonary hypertension, and renal dysfunction. Cardiopulmonary bypass and cross-clamp times, repair complexity, and concomitant procedures were comparable. In the E group, hospital mortality and stroke were both 2.4%; there were no conversions to sternotomy, re-explorations for bleeding, or new renal replacement therapy. At discharge, mitral regurgitation was none or trivial in most patients in both groups. At 5 years, overall survival was lower in the E group (80.3% vs. 97.3%), but freedom from cerebrovascular events, reoperation, and moderate or greater mitral regurgitation was similar. Conclusions: RMVr is a feasible and durable surgical option in selected octogenarians considering patient-specific risk, anatomical suitability, and institutional expertise.