A Population-Based Analysis of Robotic-Assisted Mitral Valve Repair

doi:10.1016/j.athoracsur.2014.12.043

The Annals of Thoracic Surgery

Volume 99, Issue 5, May 2015, Pages 1546-1553

https://doi.org/10.1016/j.athoracsur.2014.12.043 Get rights and content

Background

Robotic-assisted mitral valve repair is becoming more frequently performed in cardiac surgery. However, little is known about its utilization and safety at a national level.

Methods

Patients undergoing mitral valve repair in the United States from 2008 to 2012 were identified in the National Inpatient Sample. Inhospital mortality, complications, length of stay, and cost for patients undergoing robotic-assisted mitral valve repair were compared with patients undergoing nonrobotic procedures.

Results

We identified 50,408 isolated mitral valve repair surgeries, of which 3,145 were done with robotic assistance. In a propensity score matched analysis of 631 pairs of patients, we found no difference between patients undergoing robotic-assisted and nonrobotic-assisted mitral valve repair with respect to inhospital mortality, complications, or composite outcomes in unadjusted or multivariable analyses. Robotic-assisted mitral valve repair surgery was associated with a shorter median length of stay (4 versus 6 days, p < 0.001), and there was no difference in median total costs between the two procedures.

Conclusions

In our analysis of a large national database with its inherent limitations, robotic-assisted mitral valve repair was found to be safe, with an acceptable morbidity and mortality profile.

Section snippets

Data Source

The NIS is the largest all-payer inpatient care database in the United States and constitutes approximately a 20% stratified sample of all hospital discharges from nongovernment institutions. An extensive description of the NIS and the collection and maintenance of data within the database is described elsewhere 8, 9 (available at: http://www.hcup-us.ahrq.gov/nisoverview.jsp). This study was approved by the Institutional Review Board of Weill Cornell Medical College (protocol no. EXE-2011-057)

Results

From October 2008 to December 2012, 50,408 isolated mitral valve repair admissions were identified, of which 3,145 (6.2%) were performed with robotic assistance (Table 1). Patients who underwent robotic-assisted mitral valve repair were younger with a higher proportion of males undergoing the procedure. These patients also had fewer comorbidities than patients who underwent nonrobotic repair and were more likely to have commercial insurance.

The characteristics of hospitals performing these

Comment

The introduction of robotics into surgery has been complex and is still evolving. The first robotic-assisted mitral valve repair was performed in 1998 by Carpentier in France and Mohr in Germany 13, 14. Several large single-institution series examining the outcomes of robotic-assisted mitral valve surgery have been published. Robotic-assisted mitral valve surgery in these series has, in general, been found to be safe and effective. However, these reports are from high-volume centers with

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Original articleAdult cardiacA Population-Based Analysis of Robotic-Assisted Mitral Valve Repair

Background

Methods

Results

Conclusions

Section snippets

Data Source

Results

Comment

Ann Thorac Surg

J Thorac Cardiovasc Surg

Heart Lung Circ

J Thorac Cardiovasc Surg

Ann Thorac Surg

Surgery

J Thorac Cardiovasc Surg

Original article
Adult cardiac
A Population-Based Analysis of Robotic-Assisted Mitral Valve Repair