The Effects of Modern Robotic Technology on Clinical Outcomes of Mitral Valve Surgery
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:
MP069
Submission Type:
Abstract Submission
Authors:
Katherine Nordick (1), Zachary Gray (1), Alexis Shafii (2), Gabriel Loor (2), Todd Rosengart (2), Kenneth K. Liao (2)
Institutions:
(1) Baylor College of Medicine, Houston, TX, (2) Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX
Submitting Author:
Katherine Nordick
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Baylor College of Medicine
Baylor College of Medicine
Co-Author(s):
Zachary Gray
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Baylor College of Medicine
Baylor College of Medicine
*Alexis Shafii
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Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute
Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute
*Gabriel Loor
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Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute
Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute
*Todd Rosengart
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Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute
Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute
Kenneth K. Liao
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Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute
Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute
Presenting Author:
Katherine Nordick
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Abstract:
Objective: Robotic technology has improved over the past two decades and robotic surgery has been shown to be largely equivalent and even superior to conventional surgical approaches in many surgical specialties. The adaptation of robotic cardiac surgery has been particularly slow due to mixed outcomes. The purpose of this study was to compare the clinical outcomes of patients who had robotic (Rob) MVR using the most advanced robotic technology (4th generation) with those who had conventional MVR at our institution.
Methods: Average Society of Thoracic Surgeons (STS) risk scores were used to compare the patient groups preoperatively (unpaired samples t-test). STS performance metrics and blood transfusion data were used to compare clinical outcomes (two-sided Fisher's exact test). STS metrics included operative mortality, permanent stroke, reoperation, prolonged ventilation, renal failure, deep sternal wound (DSW) infection, short length of stay (LOS), and composite morbidity and mortality. These metrics were calculated as event rate percentage. Transfusion rates were calculated as average units of red blood cells (RBCs) given per case that required transfusion.
Results: A total of 327 patients underwent MVR from January 2019 to July 2022 (Rob n=154 vs conventional n=173). The two cohorts were comparable in baseline characteristics and risk factors based on STS risk: Rob 2.58±3.56% vs conventional 2.54±4.35%, p=0.88. Patients were further divided into repair (Rob n=92 vs conventional n=58) and replacement (Rob n=62 vs conventional n=115). STS performance metrics for Rob vs conventional repair and replacement are shown in Table 1: the Rob repair group performed significantly better with regard to reoperation, prolonged ventilation, short LOS, composite morbidity and mortality (p<0.05) and the Rob replacement group performed significantly better with regard to short LOS (p<0.05).
Blood transfusion rates were as follows: Rob vs conventional repair 1.8 vs 3.6 and Rob vs conventional replacement 2.9 vs 5.3 units of RBCs per transfused case.
Conclusions: Compared to conventional methods, Rob repair demonstrated significant reductions in reoperation, ventilation time, and composite morbidity and mortality. Also, all robotic cases demonstrated a significant reduction in hospital LOS and the amount of blood required for transfusion by approximately 50%. The value of modern robotic technology in cardiac surgery should be reexamined.
Methods: Average Society of Thoracic Surgeons (STS) risk scores were used to compare the patient groups preoperatively (unpaired samples t-test). STS performance metrics and blood transfusion data were used to compare clinical outcomes (two-sided Fisher's exact test). STS metrics included operative mortality, permanent stroke, reoperation, prolonged ventilation, renal failure, deep sternal wound (DSW) infection, short length of stay (LOS), and composite morbidity and mortality. These metrics were calculated as event rate percentage. Transfusion rates were calculated as average units of red blood cells (RBCs) given per case that required transfusion.
Results: A total of 327 patients underwent MVR from January 2019 to July 2022 (Rob n=154 vs conventional n=173). The two cohorts were comparable in baseline characteristics and risk factors based on STS risk: Rob 2.58±3.56% vs conventional 2.54±4.35%, p=0.88. Patients were further divided into repair (Rob n=92 vs conventional n=58) and replacement (Rob n=62 vs conventional n=115). STS performance metrics for Rob vs conventional repair and replacement are shown in Table 1: the Rob repair group performed significantly better with regard to reoperation, prolonged ventilation, short LOS, composite morbidity and mortality (p<0.05) and the Rob replacement group performed significantly better with regard to short LOS (p<0.05).
Blood transfusion rates were as follows: Rob vs conventional repair 1.8 vs 3.6 and Rob vs conventional replacement 2.9 vs 5.3 units of RBCs per transfused case.
Conclusions: Compared to conventional methods, Rob repair demonstrated significant reductions in reoperation, ventilation time, and composite morbidity and mortality. Also, all robotic cases demonstrated a significant reduction in hospital LOS and the amount of blood required for transfusion by approximately 50%. The value of modern robotic technology in cardiac surgery should be reexamined.
Mitral Conclave:
Minimally Invasive & Robotic Mitral Valve Repair
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