Chief Cardiac Surgery Yale University New Haven, Connecticut, United States
Disclosure(s): Edwards Life Science: Consultant (Ongoing); Medtronic: Financial relationships (Ongoing)
Purpose: Patient and provider interest in robotic mitral valve (MV) repair of degenerative primary mitral regurgitation (MR) is increasing. Contemporary national data on utilization and outcomes on robotic repair is lacking. The goal of this study was to analyze trends of utilization and outcomes of robotic MV repair of primary MR. Methods: Patients undergoing intended MV repair of primary MR in The STS Adult Cardiac Surgery Database (STS ACSD) between 2015 and 2021 were examined. A novel etiology and procedure-specific algorithm identified 64,253 patients undergoing first-time non-emergent cases of MV repair with/without tricuspid repair, atrial septal defect closure, surgical ablation, or left atrial appendage occlusion, that formed the study cohort. Descriptive analyses were performed to derive national and center-level volumes and outcomes. Outcomes were operative mortality (OM), composite mortality and major morbidity (MM), postoperative length of stay (LOS), and conversion to mitral valve replacement (CONV). Center volume was evaluated for robotic trends, outcomes, and CONV. Results: Through the 7-year study period, 116 surgeons across 103 hospitals performed MV repairs for primary MR robotically, comprising 12.0% (7,694/64,253) of all MV repairs for primary MR. Among MV repairs for primary MR, the proportion of robotic cases increased from 10.4% (953/9,123) in 2015 to 15.1% (1,260/8,354) in 2021 (Table). Over 95% of all cases were performed by 56 individual surgeons. Unadjusted OM for MV repair was 1.21% for non-robotic vs. 0.63% for robotic approach. Between 2015 and 2021, OM of robotic MV repair decreased from 0.96% to 0.24%, composite MM decreased from 6.9% to 5.5%, and LOS decreased from 5.2 to 4.6 days. The median center-level cumulative case volume was 19 (IQR 5.5-70.5). A monotonic reduction in OM was observed as center volume increased, particularly at sites perfoming greater than 50 cases (Figure). OM at centers performing < 10, 11-25, 26-50, 50-100, 101-200 and >200 cases cumulatively was 4.9%, 1.0%, 1.8%, 0.5%, 0.4% and 0.4%, respectively. Rate of failed repair requiring CONV was very low (0.7%) and was not associated with center volume. Conclusion: An increasing proportion of MV repair for primary MR is performed robotically. Robotic MV repair is associated with low OM+MM that decreased over time. These data support robotic MV repair as an excellent option for primary MR and suggest that higher volume centers adopting robotic techniques may maintain excellent outcomes.
Identify the source of the funding for this research project: None
