DOI: 10.1177/15569845261495530 ISSN: 1556-9845

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

Kosuke Nakamae, Yoshitsugu Nakamura, Daiki Yoshiyama, Yuto Yasumoto, Miho Kuroda, Shintaro Sawa, Yuka Higuma, Kusumi Niitsuma, Masaki Ushijima, Akihiro Higashino, Yujiro Hayashi, Taisuke Nakayama, Hiroaki Yusa, Ryo Tsuruta, Yujiro Ito
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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.

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