Outcomes of Robotic-Assisted versus Non-Robotic Approaches in Concomitant Mitral and Tricuspid Valve Repair Procedures
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP043
Submission Type:
Abstract Submission
Authors:
Alyssa Morrison (1), Christina Waldron (1), Weiguo Ma (2), Andrea Amabile (1), Sigurdur Ragnarsson (2), Syed Usman Bin Mahmood (2), Markus Krane (2), Arnar Geirsson (2)
Institutions:
(1) Yale School of Medicine, New Haven, CT, (2) Yale New Haven Hospital, New Haven, CT
Submitting Author:
Alyssa Morrison
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Yale School of Medicine
Yale School of Medicine
Co-Author(s):
Christina Waldron
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Yale School of Medicine
Yale School of Medicine
Weiguo Ma
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Yale New Haven Hospital
Yale New Haven Hospital
Andrea Amabile
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Yale School of Medicine
Yale School of Medicine
Sigurdur Ragnarsson
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Yale New Haven Hospital
Yale New Haven Hospital
Syed Usman Bin Mahmood
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Yale New Haven Hospital
Yale New Haven Hospital
Markus Krane
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Yale New Haven Hospital
Yale New Haven Hospital
*Arnar Geirsson
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Yale New Haven Hospital
Yale New Haven Hospital
Presenting Author:
Alyssa Morrison
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Yale
Yale
Abstract:
Objective: To compare early and mid-term outcomes of robotic vs non-robotic approaches to concomitant mitral valve (MV) and tricuspid valve (TV) repair.
Methods: Data were analyzed for 69 adults (age 70±11.5 years; 36 men, 52.2%) with concomitant MV and TV repair from 2014-22 for primary mitral regurgitation (MR) (52), secondary MR (15), and infective endocarditis (2). Concomitant CABG or aortic valve replacement was excluded.
Results: There were 33 robotic-assisted and 36 non-robotic cases (26 sternotomy, 10 thoracotomy). The two groups were otherwise comparable at baseline (Table 1), except that robotic patients were significantly older (73.1±8.8 vs 66.7±12.9, P=.021).
MV and TV annuloplasty were performed in 95.7% and 100%, respectively. Maze ablation was done in 51.5% of robotic and 43.5% of non-robotic patients (P=.197). Cardiopulmonary bypass (CPB) time was significantly longer in the robotic group (168±40 vs 136±31 min, P<.001), while cross-clamp time was not (103±28 vs 106±26, P=.567). More robotic patients were extubated in operating room (OR) (27.3% vs 2.8%; P=.005).
There was no significant difference in early mortality or major morbidity as well as requirement for permanent pacemaker implantation (PPI) between the robotic and non-robotic groups. Median lengths of ICU stay (2.0 vs 4.2 days; interquartile range [IQR] 1.3-3.7 vs 2.1-5.1, P=.012) and hospital stay (6 vs 10.6 days; IQR 4-7 vs 5.3-12.0; P=.008) were significantly shorter in the robotic group.
During follow-up (100% complete) at mean 3.4±2.2 years, none required reoperation. Survival was 84.5±5.6% at 5 years and did not differ significantly by approach (P=.950). Age at surgery (year) predicted all-cause death (hazard ratio [HR] 1.09; P=.036), and Maze ablation predicted PPI (HR 4.32; P=.028).
Echocardiographic results were available in 100% of cases with mean follow-up of 2.7±2.4 years. Most recent echocardiogram indicated ≤ mild MV regurgitation in 93.9% of robotic and 86.1% of non-robotic patients (P=.431) and ≤ mild TV regurgitation in 84.8% of robotic and 91.7% of non-robotic patients (P=.466).
Conclusions: Compared to non-robotic approach, robotic MV and TV repair showed advantages in OR extubation, and shorter lengths of ICU and hospital stay. Robotic-assisted approach allows for excellent results with modest but significantly longer CPB times without longer cross-clamp times in concomitant left- and right-sided cardiac operations.
Methods: Data were analyzed for 69 adults (age 70±11.5 years; 36 men, 52.2%) with concomitant MV and TV repair from 2014-22 for primary mitral regurgitation (MR) (52), secondary MR (15), and infective endocarditis (2). Concomitant CABG or aortic valve replacement was excluded.
Results: There were 33 robotic-assisted and 36 non-robotic cases (26 sternotomy, 10 thoracotomy). The two groups were otherwise comparable at baseline (Table 1), except that robotic patients were significantly older (73.1±8.8 vs 66.7±12.9, P=.021).
MV and TV annuloplasty were performed in 95.7% and 100%, respectively. Maze ablation was done in 51.5% of robotic and 43.5% of non-robotic patients (P=.197). Cardiopulmonary bypass (CPB) time was significantly longer in the robotic group (168±40 vs 136±31 min, P<.001), while cross-clamp time was not (103±28 vs 106±26, P=.567). More robotic patients were extubated in operating room (OR) (27.3% vs 2.8%; P=.005).
There was no significant difference in early mortality or major morbidity as well as requirement for permanent pacemaker implantation (PPI) between the robotic and non-robotic groups. Median lengths of ICU stay (2.0 vs 4.2 days; interquartile range [IQR] 1.3-3.7 vs 2.1-5.1, P=.012) and hospital stay (6 vs 10.6 days; IQR 4-7 vs 5.3-12.0; P=.008) were significantly shorter in the robotic group.
During follow-up (100% complete) at mean 3.4±2.2 years, none required reoperation. Survival was 84.5±5.6% at 5 years and did not differ significantly by approach (P=.950). Age at surgery (year) predicted all-cause death (hazard ratio [HR] 1.09; P=.036), and Maze ablation predicted PPI (HR 4.32; P=.028).
Echocardiographic results were available in 100% of cases with mean follow-up of 2.7±2.4 years. Most recent echocardiogram indicated ≤ mild MV regurgitation in 93.9% of robotic and 86.1% of non-robotic patients (P=.431) and ≤ mild TV regurgitation in 84.8% of robotic and 91.7% of non-robotic patients (P=.466).
Conclusions: Compared to non-robotic approach, robotic MV and TV repair showed advantages in OR extubation, and shorter lengths of ICU and hospital stay. Robotic-assisted approach allows for excellent results with modest but significantly longer CPB times without longer cross-clamp times in concomitant left- and right-sided cardiac operations.
Mitral Conclave:
Minimally Invasive & Robotic Mitral Valve Repair
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