Robotic versus port-access mitral repair: A propensity score analysis

Yaron D. Barac, Rahul S. Loungani, Richard Sabulsky, Brittany Zwischenberger, Jeffrey Gaca, Keith Carr, Donald D. Glower

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Port-access (PORT) and robotic (ROBO) mitral repair are well established, but differences in patient selection and outcomes are not well documented. Methods: A retrospective analysis was performed on 129 ROBO and 628 PORT mitral repairs at one institution. ROBO patients had 4 cm nonrib spreading incisions with robotic assistance, while PORT patients had 6–8 cm rib spreading incisions with thoracoscopic assistance. Propensity score analysis matched patients for differences in baseline characteristics. Results: Unmatched ROBO patients were younger (58 ± 11 vs. 61 ± 13, p =.05), had a higher percentage of males (77% vs. 63%, p =.003) and had less NYHA Class 3–4 symptoms (11% vs. 21%, p <.01), less atrial fibrillation (19% vs. 29%, p =.02) and less tricuspid regurgitation (14% vs. 24%, p =.01). Propensity score analysis of matched patients showed that pump time (275 ± 57 vs. 207 ± 55, p <.0001) and clamp time (152 ± 38 vs. 130 ± 34, p <.0001) were longer for ROBO patients. However, length of stay, postoperative morbidity, and 5-year survival (97 ± 1% vs. 96 ± 3%, p =.7) were not different. For matched patients with degenerative valve disease, 5-year incidence of mitral reoperation (3 ± 2% vs. 1 ± 1%), severe mitral regurgitation (MR) (6 ± 4% vs. 1 ± 1%), or ≥2 + MR (12 ± 5% vs. 12 ± 4%), were not significantly different between ROBO versus PORT approaches. Predictors of recurrent moderate MR were connective tissue disease, functional etiology, and non-White race, but not surgical approach. Conclusions: In this first comparison out to 5 years, robotic versus port-access approach to mitral repair had longer pump and clamp times. Perioperative morbidity, 5-year survival, and 5-year repair durability were otherwise similar.

Original languageEnglish
Pages (from-to)1219-1225
Number of pages7
JournalJournal of Cardiac Surgery
Volume36
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • minimally-invasive
  • mitral repair
  • robotics

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