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Robotic Approach to Mitral Valve Surgery in Septo-Octogenarians
Neel K Ranganath1, Didier F Loulmet1, Siyamek Neragi-Miandoab1
1Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
Seminars in Thoracic and Cardiovascular Surgery
|January 21, 2020
Summary
Advanced age does not preclude robotic mitral valve surgery. Totally endoscopic robotic mitral valve surgery (TERMS) in patients 70 and older demonstrated comparable safety and excellent recovery, outperforming predicted outcomes.
Area of Science:
- Cardiovascular Surgery
- Robotic Surgery
- Geriatric Medicine
Background:
- Advanced age is associated with increased risks in mitral valve surgery.
- Robotic-assisted approaches are sometimes considered contraindicated in elderly patients.
- The Society of Thoracic Surgeons (STS) predicted risk scores often reflect higher mortality and longer hospital stays for older patients.
Purpose of the Study:
- To evaluate the feasibility and safety of totally endoscopic robotic mitral valve surgery (TERMS) in patients aged 70 years and older.
- To compare outcomes of TERMS in septo-octogenarian patients (≥70 years) versus younger patients (<70 years).
- To assess the performance of TERMS against STS predicted risk scores in elderly patients.
Main Methods:
- Analysis of 570 consecutive TERMS cases performed between May 2011 and April 2018 by a single surgical team.
- Comparison of demographic, intraoperative, and outcome data between patients ≥70 years and <70 years.
- Exclusion of patients requiring left ventricle patch reconstruction after mitral annular calcification resection.
- Comparison of outcomes for patients with STS predicted risk scores against actual results.
Main Results:
- Patients ≥70 years constituted 25% of the cohort and had higher rates of preoperative atrial fibrillation, congestive heart failure, and higher STS predicted mortality risks.
- Patients ≥70 years experienced similar cardiopulmonary bypass and aortic occlusion times compared to younger patients.
- Thirty-day mortality was comparable between groups (P = 0.151), with a median length of stay (LOS) of 4 days for patients ≥70 versus 3 days for younger patients (P < 0.001).
- Short LOS (<6 days) was achieved in 72% of patients ≥70, significantly exceeding the STS predicted rate of 36%.
Conclusions:
- Advanced age is not a contraindication for robotic mitral valve surgery in most patients.
- TERMS in patients ≥70 years achieves outcomes comparable to STS benchmarks.
- TERMS in elderly patients leads to excellent recovery, evidenced by a high rate of short hospital stays.
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