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Robotic Mitral Valve Repair Mid-Term Outcomes
Study Questions:
What are the mid-term results for robotic mitral valve (MV) repair of mitral regurgitation (MR) among patients with simple and complex degenerative disease?
Methods:
From January 2008 to January 2015, 487 patients (56 ± 11 years, 360 men, ejection fraction 65 ± 6%, 98.8% complete follow-up) underwent robotic MV repair for severe nonischemic degenerative MR at a single high-volume center. Simple pathology was addressed in 289/487 (59%), and complex repair (all others) was performed in 198/487 (41%) patients.
Results:
Four patients died during follow-up, with a 5-year survival rate of 99.5% (99.4% simple and 99.5% complex; hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.05-4.59), and New York Heart Association functional class I/II was documented in 97.9% (477/487) of patients (p = 0.67; HR, 1.36; 95% CI, 0.34-5.43). Seven patients (two simple, five complex), underwent mitral reoperation, with a 5-year freedom from reoperation of 97.7% (99.2% simple and 95.7% complex; p = 0.13; HR, 3.35; 95% CI, 0.65-17.32).
Conclusions:
At a large tertiary care referral center, mid-term quality outcomes after robotic correction of degenerative MR are excellent, with very high survival, infrequent complications, and a low likelihood of MR recurrence regardless of MV repair complexity. The authors concluded that awareness of these improvements in outcome is important to inform contemporary decisions regarding high-quality alternatives to conventional and percutaneous mitral repair.
Perspective:
A compromise exists between conventional open-chest surgery (with greater exposure and presumably higher rates of successful MV repair) and less invasive alternatives (potentially including transcatheter therapies, ‘minimally invasive’ surgery, and robotic-assisted surgery; with potentially less definitive treatment of MR). This study demonstrates that, at a single high-volume referral center, robotic-assisted mitral repair for degenerative MR can have excellent clinical and echocardiographic results at 5-year follow-up. Notably, patient selection and operator expertise are critical. This report suggests that, in the right setting, less invasive alternatives like robotic-assisted mitral repair have far superior results to currently available transcatheter therapies.
Keywords: Echocardiography, Heart Valve Diseases, Minimally Invasive Surgical Procedures, Mitral Valve Insufficiency, Reoperation, Robotics, Survival Rate, Tertiary Healthcare
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