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Robotically assisted mitral valve surgery-experience during the restart of a robotic program in Germany
Ulrich F W Franke1, Franziska Huether1, Mihnea Ghinescu1
1Department for Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
Annals of Cardiothoracic Surgery
|December 9, 2022
Summary
Robotic mitral valve repair in Germany shows successful outcomes comparable to minimally invasive techniques, with faster recovery and shorter hospital stays. Despite higher initial costs, this approach offers significant long-term benefits.
Area of Science:
- Cardiac Surgery
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Robotic-assisted cardiac surgery was previously discontinued in Germany due to concerns about cost-effectiveness and operative time.
- A renewed effort to establish robotic mitral valve surgery began in 2019 at a single center in Germany.
- Initial concerns focused on economic viability and efficiency of robotic surgical procedures.
Purpose of the Study:
- To re-evaluate the efficacy and safety of robotic-assisted mitral valve repair in Germany.
- To compare outcomes of robotic mitral valve surgery with traditional minimally invasive mitral surgery (MIMS).
- To assess the learning curve and cost-effectiveness of re-establishing robotic cardiac surgery.
Main Methods:
- A total of 329 patients underwent robotic-assisted operations between July 2019 and December 2021 using the daVinci Xi system.
- 182 patients had mitral valve repair (MVR), including isolated MVR (96 patients) and concomitant procedures (86 patients).
- Cost analysis utilized the InEK calculation for 2020; outcomes were compared to MIMS data from 2020.
Main Results:
- Mitral valve repair was successful in all patients (MR ≤I°).
- Hospital mortality was 1.0% for isolated MVR and 3.5% for complex MVR; stroke rates were 2.0% and 2.3%, respectively.
- Robotic surgery demonstrated a significant reduction in operating times (>25%) after the learning curve and a ~25% shorter hospital stay compared to MIMS, leading to lower overall costs despite higher initial material expenses.
Conclusions:
- The re-establishment of robotic mitral valve surgery in Germany is successful, yielding results comparable to MIMS regarding mortality and morbidity.
- Robotic-assisted cardiac operations facilitate accelerated postoperative recovery and significantly shorten hospital stays.
- Future focus includes optimizing the technique to avoid complications like liver injury.
