MP43. Outcomes of Robotic-Assisted versus Non-Robotic Approaches in Concomitant Mitral and Tricuspid Valve Repair Procedures
Presented During: Moderated E-Posters
Yale
New Haven, CT
United States - Contact Me
Alyssa Morrison is a fourth-year medical student at Yale School of Medicine where she is completing a research year under the mentorship of Arnar Geirsson, MD in cardiac surgery focused on surgical outcomes.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
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.