MP75. Totally Endoscopic, Robotic-Assisted Mitral Valve Surgery in Octogenarians and Nonagenarians: Short–Term Outcomes
Presented During: Moderated E-Posters
University of Pittsburgh Medical Center
PITTSBURGH, PA
United States - Contact Me
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Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective: The adoption of anterolateral minithoracotomy for mitral valve surgery in elderly patients has proven to be safe and effective. Whether the same benefits persist in octo–nonagenarians undergoing robotic-assisted procedures remains unclear. We aimed to evaluate short-term outcomes of octo–nonagenarians undergoing totally endoscopic, robotic-assisted mitral valve surgery at a quaternary academic institution.
Methods: We performed a retrospective, cohort study including patients who underwent totally endoscopic, robotic-assisted mitral valve surgery between 08/2019 and 08/2022. Demographics, comorbidities, intraoperative, and postoperative data were collected from our Society of Thoracic Surgeons (STS) institutional database.
Results: Twenty-one patients met inclusion criteria. Median age was 82 years (range, 80–91). Demographics and comorbidities are detailed in Table 1. Eighteen patients (85.7%) underwent a variety of robotic-assisted mitral valve repair techniques (7 triangular resections, 1 sliding annuloplasty, 5 clefts closure, 4 commissural plications, 4 anterior neochordoplasty, 4 posterior neochordoplasty, 1 commissural neochordoplasty); all patients underwent concomitant mitral annuloplasty, with a median annuloplasty band size of 30 (28–32) mm. All patients had satisfactory repair. Three patients (14.3%) underwent robotic-assisted mitral valve replacement, with a median prosthesis size of 27 (25–33) mm. Left atrial appendage exclusion was performed in all patients, and tricuspid valve repair in 7 patients (33.3%).
Cardiopulmonary bypass and cross-clamp times were 138±42 and 89±31 minutes, respectively. No intraoperative complications occurred, and 9 patients (42.9%) were extubated in the operating room. Overall, the median STS predicted risk of mortality was 2.7% [1.7%–3.9%], the median predicted risk of morbidity and mortality was 11.2% [9.6–17.0%], the median predicted risk of prolonged ventilation was 6.8% [5.5–11.6%], and the median predicted risk of stroke was 2.3% [1.9–3.0%]. Postoperatively, one patient developed pleural effusion, one patient deep venous thrombosis, and one patient required permanent pacemaker implantation. Neither intraoperative, nor in-hospital, or 30-day deaths occurred.
Conclusion: Results of this study suggest that octogenarians and nonagenarians can safely and effectively undergo totally endoscopic, robotic–assisted mitral valve surgery with satisfactory surgical and short-term outcomes.
Methods: We performed a retrospective, cohort study including patients who underwent totally endoscopic, robotic-assisted mitral valve surgery between 08/2019 and 08/2022. Demographics, comorbidities, intraoperative, and postoperative data were collected from our Society of Thoracic Surgeons (STS) institutional database.
Results: Twenty-one patients met inclusion criteria. Median age was 82 years (range, 80–91). Demographics and comorbidities are detailed in Table 1. Eighteen patients (85.7%) underwent a variety of robotic-assisted mitral valve repair techniques (7 triangular resections, 1 sliding annuloplasty, 5 clefts closure, 4 commissural plications, 4 anterior neochordoplasty, 4 posterior neochordoplasty, 1 commissural neochordoplasty); all patients underwent concomitant mitral annuloplasty, with a median annuloplasty band size of 30 (28–32) mm. All patients had satisfactory repair. Three patients (14.3%) underwent robotic-assisted mitral valve replacement, with a median prosthesis size of 27 (25–33) mm. Left atrial appendage exclusion was performed in all patients, and tricuspid valve repair in 7 patients (33.3%).
Cardiopulmonary bypass and cross-clamp times were 138±42 and 89±31 minutes, respectively. No intraoperative complications occurred, and 9 patients (42.9%) were extubated in the operating room. Overall, the median STS predicted risk of mortality was 2.7% [1.7%–3.9%], the median predicted risk of morbidity and mortality was 11.2% [9.6–17.0%], the median predicted risk of prolonged ventilation was 6.8% [5.5–11.6%], and the median predicted risk of stroke was 2.3% [1.9–3.0%]. Postoperatively, one patient developed pleural effusion, one patient deep venous thrombosis, and one patient required permanent pacemaker implantation. Neither intraoperative, nor in-hospital, or 30-day deaths occurred.
Conclusion: Results of this study suggest that octogenarians and nonagenarians can safely and effectively undergo totally endoscopic, robotic–assisted mitral valve surgery with satisfactory surgical and short-term outcomes.