Benefits of Robotic Mitral Valve Repair in Older Adult Patients: An Adjusted Comparison With Standard Sternotomy

The prevalence of mitral regurgitation (MR) increases with age, but the invasiveness of surgical intervention may delay treatment in older adult patients. The present study compares the results of robotic mitral valve (MV) repair in patients aged more than 65 years with outcomes of MV repair performed by median sternotomy.

The study identified 613 patients aged 65 years or older who underwent isolated MV repair for the first time through a robotic approach or standard median sternotomy. Propensity score matching was used to adjust for baseline differences. Primary end points were long-term all-cause mortality, reintervention-free survival, probability of moderate or severe MR during follow-up, and quality of life outcomes.

The 189 matched patients in each group had similar baseline characteristics. The median age was 70 years (range, 67-74 years), and 33.1% of the participants were female. All patients had severe MR before operation. Overall operative mortality was 0.3%. Compared with patients in the sternotomy group, those in the robotic group required fewer blood transfusions (21% vs 32%), had a lower incidence of postoperative atrial fibrillation (33% vs 44%), and had shorter intensive care unit stays (-3 hours) and total hospital stays (-1 day). There was no significant difference in long-term survival between the matched groups (P = .65). Similarly, long-term trends of progression of MR were comparable, as were rates of MV reintervention (P = .77). Patients in both groups reported a similar degree of improvement in quality of life postoperatively.

Robotic MV repair in older patients is associated with better short-term postoperative outcomes compared with standard median sternotomy, and long-term outcomes are similar.