A Historical Perspective and Update on Robotic Mitral Valve Surgery

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Robotic Surgery

Background:

• Minimally invasive mitral valve repair techniques have advanced significantly over 30 years, including mini-thoracotomies and robotic platforms.
• This study offers a historical overview of minimally invasive mitral valve approaches and assesses long-term outcomes of robotic mitral valve repairs.

Purpose of the Study:

• To evaluate the long-term outcomes of a large series of robotic mitral valve repairs.
• To assess operative outcomes, freedom from mitral regurgitation, and survival rates following robotic mitral valve repair.

Main Methods:

• A single-institution, prospectively maintained registry analyzed 1412 robotic mitral valve repairs performed between 2005 and 2023 by four surgeons.
• Patients were stratified into the first 120 and subsequent patient groups to evaluate learning curve effects.
• Outcomes assessed included operative times, freedom from >2+ mitral regurgitation at 5 years, and 10-year survival.

Main Results:

• 93.6% of repairs were for degenerative mitral disease, with posterior leaflet prolapse being the most common indication (65.6%).
• Subsequent patient groups showed significant reductions in cross-clamp time (75 min vs. 112 min) and cardiopulmonary bypass time (116 min vs. 153.5 min) compared to the initial 120 patients (p < 0.01).
• The overall mitral valve repair rate was high at 98.1%. Ten-year survival was comparable between the initial (91.5%) and later patient groups (92.8%). Freedom from >2+ mitral regurgitation at 5 years was 97.0% and 92.7%, respectively.

Conclusions:

• The robotic platform provides an excellent and durable repair for mitral regurgitation, supported by outcomes in over 1400 patients.
• Robotic mitral valve repair is a teachable and safe approach for managing mitral valve disease, demonstrating favorable long-term results.