MP16. Early and Midterm Outcomes of Robotic Mitral Valve Repair: A Meta-Analysis
Presented During: Moderated E-Posters
Yale School of Medicine
New Haven, CT
United States - Contact Me
Cardiovascular surgeon focusing on cardiac surgery database and outcomes research
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 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.