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Original research article
A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery
  1. Robert B Hawkins1,
  2. J Hunter Mehaffey1,
  3. Matthew G Mullen1,
  4. Wiley L Nifong2,
  5. W Randolph Chitwood1,
  6. Marc R Katz3,
  7. Mohammed A Quader4,
  8. Andy C Kiser2,
  9. Alan M Speir5,
  10. Gorav Ailawadi1
  11. on behalf of the Investigators for the Virginia Cardiac Services Quality Initiative
  1. 1 Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
  2. 2 Division of Cardiac Surgery, East Carolina University, Greenville, North Carolina, USA
  3. 3 Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4 Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
  5. 5 INOVA Heart and Vascular Institute, Falls Church, Virginia, USA
  1. Correspondence to Dr Robert B Hawkins, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA; rbh6x{at}


Objectives Institutional studies suggest robotic mitral surgery may be associated with superior outcomes. The objective of this study was to compare the outcomes of robotic, minimally invasive (mini), and conventional mitral surgery.

Methods A total of 2300 patients undergoing non-emergent isolated mitral valve operations from 2011 to 2016 were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by approach: robotic (n=372), mini (n=576) and conventional sternotomy (n=1352). To account for preoperative differences, robotic cases were propensity score matched (1:1) to both conventional and mini approaches.

Results The robotic cases were well matched to the conventional (n=314) and mini (n=295) cases with no significant baseline differences. Rates of mitral repair were high in the robotic and mini cohorts (91%), but significantly lower with conventional (76%, P<0.0001) despite similar rates of degenerative disease. All procedural times were longest in the robotic cohort, including operative time (224 vs 168 min conventional, 222 vs 180 min mini; all P<0.0001). The robotic approach had comparable outcomes to the conventional approach except there were fewer discharges to a facility (7% vs 15%, P=0.001) and 1 less day in the hospital (P<0.0001). However, compared with the mini approach, the robotic approach had more transfusions (15% vs 5%, P<0.0001), higher atrial fibrillation rates (26% vs 18%, P=0.01), and 1 day longer average hospital stay (P=0.02).

Conclusion Despite longer procedural times, robotic and mini patients had similar complication rates with higher repair rates and shorter length of stay metrics compared with conventional surgery. However, the robotic approach was associated with higher atrial fibrillation rates, more transfusions and longer postoperative stays compared with minimally invasive approach.

  • valve disease surgery
  • mitral regurgitation
  • cardiac surgery

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  • Contributors All authors have provided substantial contributions to this project including conception, design, data acquisition, analysis or interpretation. Additionally all authors have either drafted parts of the manuscript or provided critical revisions and provided final approval for publication.

  • Funding This work was supported in part by the National Heart, Lung, and Blood Institute of the National Institutes of Health (T32HL007849).

  • Disclaimer The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

  • Competing interests GA is a consultant for Abbott, Edwards, Medtronic, and Cephea. AS is a consultant on the Medtronic Cardiac Surgery Advisory Board.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The Virginia Cardiac Services Quality Initiative maintains a regional database containing clinical data collected for the Society of Thoracic Surgeons (STS) adult cardiac database and financial data. Business associate agreements are in place between VCSQI, members and the database vendor (ARMUS Corporation, San Mateo, CA, USA).

  • Correction notice Since this editorial was first published online, the author Matthew Mullen’s middle initial has changed from M to G.

  • Presented at Presented at the 64th Annual Meeting for Southern Thoracic Surgical Association, November 8-11, 2017, San Antonio, Texas.