Acquired cardiovascular disease
Robotic repair of posterior mitral valve prolapse versus conventional approaches: Potential realized

Read at the 90th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 1–5, 2010.
https://doi.org/10.1016/j.jtcvs.2010.09.008Get rights and content
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Objective

Robotic mitral valve repair is the least invasive approach to mitral valve repair, yet there are few data comparing its outcomes with those of conventional approaches. Therefore, we compared outcomes of robotic mitral valve repair with those of complete sternotomy, partial sternotomy, and right mini-anterolateral thoracotomy.

Methods

From January 2006 to January 2009, 759 patients with degenerative mitral valve disease and posterior leaflet prolapse underwent primary isolated mitral valve surgery by complete sternotomy (n = 114), partial sternotomy (n = 270), right mini-anterolateral thoracotomy (n = 114), or a robotic approach (n = 261). Outcomes were compared on an intent-to-treat basis using propensity-score matching.

Results

Mitral valve repair was achieved in all patients except 1 patient in the complete sternotomy group. In matched groups, median cardiopulmonary bypass time was 42 minutes longer for robotic than complete sternotomy, 39 minutes longer than partial sternotomy, and 11 minutes longer than right mini-anterolateral thoracotomy (P < .0001); median myocardial ischemic time was 26 minutes longer than complete sternotomy and partial sternotomy, and 16 minutes longer than right mini-anterolateral thoracotomy (P < .0001). Quality of mitral valve repair was similar among matched groups (P = .6, .2, and .1, respectively). There were no in-hospital deaths. Neurologic, pulmonary, and renal complications were similar among groups (P > .1). The robotic group had the lowest occurrences of atrial fibrillation and pleural effusion, contributing to the shortest hospital stay (median 4.2 days), 1.0, 1.6, and 0.9 days shorter than for complete sternotomy, partial sternotomy, and right mini-anterolateral thoracotomy (all P < .001), respectively.

Conclusions

Robotic repair of posterior mitral valve leaflet prolapse is as safe and effective as conventional approaches. Technical complexity and longer operative times for robotic repair are compensated for by lesser invasiveness and shorter hospital stay.

CTSNet classification

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35

Abbreviations and Acronyms

ANT
mini-anterolateral thoracotomy
CST
complete sternotomy
MR
mitral regurgitation
MV
mitral valve
PST
partial sternotomy
ROB
robotic

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Funding: This study was supported in part by the Peter Boyle Research Fund and Donna and Ken Lewis Endowed Chair in Cardiothoracic Surgery (Dr Mihaljevic), the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (Dr Blackstone), the Judith Dion Pyle Chair in Heart Valve Research (Dr Gillinov), a grant from the American Association for Thoracic Surgery (awarded to Dr Jarrett), and a grant from the American Medical Education Foundation (awarded to Dr Jarrett).

Disclosures: Dr Mihaljevic is a consultant for Intuitive Surgical, Edwards Lifesciences, and St Jude Medical. Dr Gillinov is a consultant for Edwards Lifesciences, St Jude Medical, receives support from St Jude Medical and Medtronic, and has equity in Viacor. Dr Svensson is a consultant for Cardiosolutions.