Systematic review and meta-analysis of mid-term survival, reoperation, and recurrent mitral regurgitation for robotic-assisted mitral valve repair

Abstract

Background: Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid-to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid-to long-term data for RMVr.Methods: Electronic searches of five databases were performed to identify all relevant studies reporting minimum five-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and from moderate or worse mitral regurgitation (MR) at five-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data.Results: Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5-and 10-year were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at eight-years post RMVr was 95.0%. Freedom from moderate or worse MR at seven-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively.Conclusions: RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available midterm data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and from moderate or worse MR recurrence.

Atrial fibrillation ablation during robotic mitral valve surgery: a systematic review and meta-analysis

“…Two patients required conversion to sternotomy (1.4%) and eight patients required PPM insertion (3.7%). Even with small patient numbers, these results are consistent with previously published data assessing robotic mitral valve surgery ( 24 ). One explanation for this is the exclusion of higher risk patients from robotic mitral valve cohorts, such as those with elevated body mass index (BMI), difficult access, reoperation and pulmonary disease.…”

Long-Term Outcomes of Sternal-Sparing Versus Sternotomy Approaches for Mitral Valve Repair: Meta-Analysis of Reconstructed Time-to-Event Data

“…A recent meta-analysis including 9 studies and 3,300 patients undergoing robotic MVRp revealed that the rates of overall survival at 1, 5, and 10 years were 99.2%, 97.4%, and 92.3%, respectively. 26 Freedom from mitral valve reoperation at 8 years after robotic MVRp was 95.0%. Freedom from moderate or severe recurrent MR at 7 years was 86.0%.…”

Two decades of experience with robotic mitral valve repair: What have we learned?

“…Centers with expertise in robotic MV repair have obtained equal results (quality) with less morbidity (cost), and therefore more value (value = quality/cost) for their patients. 16 , 17 , 18 , 19 , 20 , 21 , 22 However, as illuminated by the aforementioned points, there are more subtle benefits from robotics fostering a more enlightened approach to MV reconstruction. 23 …”