Early and Midterm Outcomes of Robotic Mitral Valve Repair: A Meta-Analysis
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:
MP016
Submission Type:
Abstract Submission
Authors:
Wei-Guo Ma (1), Chin Siang Ong (2), Qiudong (Kevin) Chen (3), Arman Arghami (4), Joseph Canner (2), Alyssa Morrison (2), Andrea Amabile (2), Alexandria Brackett (2), Markus Krane (5), Prashanth Vallabhajosyula (1), Eric Schneider (2), Arnar Geirsson (1)
Institutions:
(1) Yale New Haven Hospital, New Haven, CT, (2) Yale School of Medicine, New Haven, CT, (3) Cedars Sinai Medical Center, Los Angeles, CA, (4) Mayo Clinic, Rochester, MN, (5) Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT
Submitting Author:
Wei-Guo Ma
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Yale New Haven Hospital
Yale New Haven Hospital
Co-Author(s):
Chin Siang Ong
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Yale School of Medicine
Yale School of Medicine
Qiudong (Kevin) Chen
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Cedars Sinai Medical Center
Cedars Sinai Medical Center
Arman Arghami
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Mayo Clinic
Mayo Clinic
Joseph Canner
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Yale School of Medicine
Yale School of Medicine
Alyssa Morrison
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Yale School of Medicine
Yale School of Medicine
Andrea Amabile
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Yale School of Medicine
Yale School of Medicine
Alexandria Brackett
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Yale School of Medicine
Yale School of Medicine
Markus Krane
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Division of Cardiac Surgery, Yale School of Medicine
Division of Cardiac Surgery, Yale School of Medicine
*Prashanth Vallabhajosyula
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Yale New Haven Hospital
Yale New Haven Hospital
Eric Schneider
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Yale School of Medicine
Yale School of Medicine
*Arnar Geirsson
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Yale New Haven Hospital
Yale New Haven Hospital
Presenting Author:
Wei-Guo Ma
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Beijing Anzhen Hospital
Beijing Anzhen Hospital
Abstract:
Objective: To assess the early outcomes and midterm survival, recurrent mitral regurgitation (MR) and reoperation of robotic MV repair.
Methods: After a systematic literature search up to 2/5/2023, 11 studies with >100 patients and late follow-up (FU) data were pooled in a random-effects meta-analysis model. All results are expressed as mean (95% confidence interval [CI]) or % (95% CI) unless otherwise stated.
Results: Of 4705 patients (men, 68.1% [62.7-73.3%]) (Table), mean age was 55.8y (53-58.6), 87.2% (70.5-97.7%) had severe MR, 18.3% (12.2-25.4%) had atrial arrhythmia, and 29.8% (20.2-40.3%) were in NYHA Class 3/4. Etiology was degenerative in 78.9% (50.7-97%) and rheumatic in 5.9% (4.8-7.2%). Posterior leaflet prolapse (LP) was seen in 64.6% (55.1-73.5%), anterior LP in 15.9% (8.5-25%) and bileaflet LP 13% (7.4-19.7%). Left atrial size was 4.7cm (4.4-4.9) and LVEDD was 5.6cm (5.1-6).
Leaflet resection was used in 52.2% (27.5-76.4%), neochords in 40% (23.3-58%), cleft closure in 19.6% (6.1-38.2%) and commissural plication in 10.8% (4.8-18.9%). Annuloplasty was used in 98.2% (95.8-99.6%) and 15.2% (10.2-21%) had ablation for atrial fibrillation (AF). Mean CPB and clamp times were 133min (115-151) and 93min (79-107). A 2nd CPB run occurred in 4.4% (2.2-7.2%), 1.5% (0.4-3.3%) were converted to open repair, and 5.4% (0.8-13.4%) had ≥2+ MR post-CPB.
Operative mortality was 0.2% (0.1-0.4%). Rate of stroke was 0.7% (0.3-1.3%), new-onset AF 17.2% (12.6-22.4%) and pacemaker insertion 1.2% (0.6-1.9%). Early reoperation on MV was done in 0.5% (0.1-1.3%) and for bleeding in 2.1% (1.2-3.3%). Mean intubation time was 7.5h (6.7-8.2) and >24h in 1.9% (0.8-3.5%). Mean ICU and hospital lengths of stay were 1d (0.7-1.3) and 5.2d (4.1-6.3).
Clinical FU was complete in 97.4% (94-99.5%) at mean 3.3y (2.2-4.4) and echocardiography FU in 87.5% (80.3-93.3%) at mean 2.1y (1.3-2.9). Late death was 2.4% (1.6-3.2%) and reoperation 2.5% (1.7-3.4%), done in 103 patients at mean 1.2y (0.5-1.9), for recurrent MR in 60.2% (62/103). Moderate MR recurred in 5.4% (3.5-7.7%) and severe MR in 2% (1.1-3.1%). At 5 years, weighted mean rates (n, range) of survival, and freedom from moderate MR and reoperation were 95.5% (n=4141, 87.6-98.2%), 88.4% (n=4481, 77-97.6%) and 96.7% (n=2681, 94.5-98.1%), respectively.
Conclusions: Robotic MV repair is safe and provides durable midterm results. Data from large series of longer duration are needed to evaluate its long-term outcomes.
Methods: After a systematic literature search up to 2/5/2023, 11 studies with >100 patients and late follow-up (FU) data were pooled in a random-effects meta-analysis model. All results are expressed as mean (95% confidence interval [CI]) or % (95% CI) unless otherwise stated.
Results: Of 4705 patients (men, 68.1% [62.7-73.3%]) (Table), mean age was 55.8y (53-58.6), 87.2% (70.5-97.7%) had severe MR, 18.3% (12.2-25.4%) had atrial arrhythmia, and 29.8% (20.2-40.3%) were in NYHA Class 3/4. Etiology was degenerative in 78.9% (50.7-97%) and rheumatic in 5.9% (4.8-7.2%). Posterior leaflet prolapse (LP) was seen in 64.6% (55.1-73.5%), anterior LP in 15.9% (8.5-25%) and bileaflet LP 13% (7.4-19.7%). Left atrial size was 4.7cm (4.4-4.9) and LVEDD was 5.6cm (5.1-6).
Leaflet resection was used in 52.2% (27.5-76.4%), neochords in 40% (23.3-58%), cleft closure in 19.6% (6.1-38.2%) and commissural plication in 10.8% (4.8-18.9%). Annuloplasty was used in 98.2% (95.8-99.6%) and 15.2% (10.2-21%) had ablation for atrial fibrillation (AF). Mean CPB and clamp times were 133min (115-151) and 93min (79-107). A 2nd CPB run occurred in 4.4% (2.2-7.2%), 1.5% (0.4-3.3%) were converted to open repair, and 5.4% (0.8-13.4%) had ≥2+ MR post-CPB.
Operative mortality was 0.2% (0.1-0.4%). Rate of stroke was 0.7% (0.3-1.3%), new-onset AF 17.2% (12.6-22.4%) and pacemaker insertion 1.2% (0.6-1.9%). Early reoperation on MV was done in 0.5% (0.1-1.3%) and for bleeding in 2.1% (1.2-3.3%). Mean intubation time was 7.5h (6.7-8.2) and >24h in 1.9% (0.8-3.5%). Mean ICU and hospital lengths of stay were 1d (0.7-1.3) and 5.2d (4.1-6.3).
Clinical FU was complete in 97.4% (94-99.5%) at mean 3.3y (2.2-4.4) and echocardiography FU in 87.5% (80.3-93.3%) at mean 2.1y (1.3-2.9). Late death was 2.4% (1.6-3.2%) and reoperation 2.5% (1.7-3.4%), done in 103 patients at mean 1.2y (0.5-1.9), for recurrent MR in 60.2% (62/103). Moderate MR recurred in 5.4% (3.5-7.7%) and severe MR in 2% (1.1-3.1%). At 5 years, weighted mean rates (n, range) of survival, and freedom from moderate MR and reoperation were 95.5% (n=4141, 87.6-98.2%), 88.4% (n=4481, 77-97.6%) and 96.7% (n=2681, 94.5-98.1%), respectively.
Conclusions: Robotic MV repair is safe and provides durable midterm results. Data from large series of longer duration are needed to evaluate its long-term outcomes.
Mitral Conclave:
Minimally Invasive & Robotic Mitral Valve Repair
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