Meta-analysis of propensity matched studies of robotic versus conventional mitral valve surgery

To compare early outcomes after robotic versus conventional mitral valve surgery (R-MVS versus C-MVS), we performed a meta-analysis of currently available propensity score matched (PSM) studies.

To identify all PSM studies of R-MVS versus C-MVS, PubMed and Web of Science were searched thorough November 2018 using the terms of robotic or robot, mitral, and propensity. Inclusion criteria were PSM studies of isolated R-MVS versus C-MVS. Odds ratios of dichotomous data and mean differences for continuous data were generated for each study and combined in a meta-analysis using the random-effects model.

We identified 7 PSM studies of R-MVS versus C-MVS enrolling a total of 3764 patients. Pooled analyses demonstrated significantly longer cardiopulmonary bypass (CPB) (p < 0.00001) and cross-clamp time (p = 0.004) in R-MVS than C-MVS. However, intensive care unit (ICU) (p = 0.0005) and hospital stay (p < 0.0001) was significantly shorter; and incidence of red blood cell (RBC) transfusion (p = 0.03), prolonged ventilation (p = 0.048), and atrial fibrillation (AF) (p = 0.01) was significantly less frequent after R-MVS than C-MVS. There was no significant difference in incidence of reoperation for bleeding and valve dysfunction, ≥moderate mitral regurgitation, renal failure, dialysis, pneumonia, stroke, cardiac arrest, and all-cause death (p = 0.27) between R-MVS and C-MVS.

ICU/hospital stay was shorter and RBC transfusion/prolonged ventilation/AF was less frequent after R-MVS than C-MVS despite longer CPB and cross-clamp time in R-MVS than C-MVS. The other early outcomes including all-cause mortality were similarly frequent after R-MVS and C-MVS.