MP69. The Effects of Modern Robotic Technology on Clinical Outcomes of Mitral Valve Surgery
Presented During: Moderated E-Posters
Houston, TX
United States - Contact Me
Dr. Katherine Nordick is currently a general surgery resident at Baylor College of Medicine in her first year of research focusing on heart failure, heart transplantation, and minimally invasive cardiac surgery at Baylor St. Luke's Medical Center (BSLMC)/Texas Heart Institute (THI). She received a BA in biomedical engineering from Dartmouth College and an MD from Creighton University School of Medicine.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
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.