Comparison of the Surgical Effect and the Long-term Clinical Outcomes Between Robotic and Sternotomy Mitral Valve Replacement

Abstract

BackgroundRobot-assisted mitral valve surgery has been increasingly used by surgeons to achieve better results. This study was to assess the safety and effectiveness of totally endoscopic robotic mitral valve replacement (TE-MVR) and to provide evidence that it is a reasonable surgical choice by analyzing the clinical experience, surgical efficacy, and follow-up outcomes of this procedure.MethodBetween October 2008 and October 2015, 47 patients underwent da Vinci TE-MVR. From March 2002 to June 2014, 293 patients underwent conventional sternotomy mitral valve replacement (CS-MVR), of whom 47 patients were selected to match the TE-MVR group (1:1). We performed a retrospective study by collecting perioperative data and assessed TE-MVR efficacy by comparing clinical outcomes and echocardiography with CS-MVR in a 10-year follow-up period.ResultsAll cases were conducted successfully. No operative deaths were observed, and the complications were not significantly different between the groups. The cardiopulmonary bypass time (122.02±25.45 min) and aortic cross-clamping time (85.68±20.70 min) were longer in TE-MVR group (P<0.001). The perioperative complications are similar in two groups, but the drainage volume, blood product transfusion, ICU stay and postsurgical hospital stay are better in robotic group (P<0.001). During the follow-up period, 42 patients (89.4%) in TE-MVR group and 40 patients (87.0%) in CS-MVR group were followed. Long-term event-free survival is similar in both groups. ConclusionRobotic MVR is a feasible, effective and safe minimally-invasive alternative to sternotomy MVR, and the long-term clinical and echocardiographic results are comparable to sternotomy MVR in selected patients.

Comparative efficacy of five surgical methods in the treatment of mitral regurgitation: A systematic review and network meta‐analysis

“…There were 1892 relevant articles retrieved ultimately, among which 272 were duplicate articles. After screening layer by layer, 31 4–33 articles were finally included, including 24 in English and 7 in Chinese, including 18 propensity matching studies and 4 master's thesis. Figure 1 shows the screening process.…”