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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 2,351 patients undergoing non-emergent isolated mitral valve operations from 2011–2016 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 Robotic cases were well matched to conventional (n=314) and mini (n=295) 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 minutes conventional, 222 vs 180 minutes mini; all p<0.0001). Robotic approach had comparable outcomes to conventional except fewer discharges to a facility (7% vs 15%, p=0.001) and 1 less day in the hospital (p<0.0001). However, compared to mini, robotic approach had higher transfusion (15% vs 5%, p<0.0001), 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 to conventional surgery. However, robotic approach is associated with greater atrial fibrillation, transfusion and longer postoperative stays compared to minimally invasive approach.

The convergent procedure effectively combines surgical and electrophysiological AF expertise to provide a viable treatment option to patients with persistent AF or LSPAF. Long-term follow-up is under way.

Background: The effects of socioeconomic factors other than insurance status and race on outcomes following cardiac surgery are not well understood. We hypothesized that the Distressed Communities Index (DCI), a comprehensive socioeconomic ranking by zip code, would predict operative mortality following coronary artery bypass grafting (CABG). Methods: All patients who underwent isolated CABG (2010-2017) in the Virginia Cardiac Services Quality Initiative database were analyzed. The DCI accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies, with scores ranging from 0 (no distress) to 100 (severe distress). Patients were stratified by DCI quartiles (I: 0-24.9, II: 25-49.9, III: 50-74.9, IV: 75-100) and compared. Hierarchical linear regression modeled the association between DCI and mortality. Results: A total of 19,756 CABG patients were analyzed, with mean PROM of 2.0±3.5%. Higher DCI scores were associated with increasing PROM. Overall operative mortality was 2.1% [n=424] and increased with increasing DCI quartile (I: 1.6% [95], II: 2.1% [77], III: 2.4% [114],