July 16, 2018
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Robotic, mini-thoracotomy for mitral valve repair confer similar outcomes to conventional surgery

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Patients who underwent robotic or mini-thoracotomy surgery for mitral valve repair had similar complication rates, shorter lengths of stay and higher repair rates compared with those who underwent conventional surgery despite longer procedural times, according to a study published in Heart.

Robert B. Hawkins, MD, postdoctoral research fellow in the department of surgery at University of Virginia School of Medicine in Charlottesville, and colleagues analyzed data from 2,300 patients who underwent isolated mitral valve surgery from 2011 to 2016. Exclusion criteria included emergent or emergent salvage procedures.

Patients were categorized by surgical approach: robotic surgery (n = 372), minimally invasive via mini-thoracotomy (n = 576) or conventional median sternotomy (n = 1,352). Those who underwent robotic surgery were propensity score matched to the minimally invasive approach and the conventional surgical approach separately.

The robotic and mini-thoracotomy groups had higher rates of mitral repair compared with the conventional group (91% vs. 76%; P < .0001) despite similar rates of degenerative mitral disease.

Patients who underwent robotic surgery had longer procedure times compared with the conventional approach (224 minutes vs. 168 minutes; P < .0001) and the mini-thoracotomy approach (222 minutes vs. 180 minutes; P < .0001).

The robotic surgery group had comparable outcomes compared with the conventional group, although patients who underwent robotic surgery had 1 less day in the hospital (P < .0001) and fewer discharges to a facility (7% vs. 15%; P = .001). Compared with patients who underwent surgery via the mini-thoracotomy approach, those who underwent the robotic approach had higher rates of atrial fibrillation (26% vs. 18%; P = .01), transfusions (15% vs. 5%; P < .0001) and 1 day longer average hospital stay (P = .02).

“When looking to add technical expertise, surgeons should consider the improved resource utilization and outcomes associated with a minimally invasive approach,” Hawkins and colleagues wrote. “From a patient perspective, all three approaches provide excellent outcomes, thus patient preference and surgeon experience should dictate the approach for mitral valve surgery.” – by Darlene Dobkowski

Disclosures: Hawkins reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.