Robotic vs. sternotomy mitral valve replacement in rheumatic disease: early postoperative outcomes compared

This study aims to compare early postoperative outcomes of robotic-assisted mitral valve replacement (r-MVR) and conventional sternotomy-based mitral valve replacement (c-MVR) in patients with rheumatic mitral valve disease (RMVD).

A retrospective analysis included 225 adult patients who underwent isolated MVR for RMVD between November 2018 and December 2023. Among them, 105 underwent r-MVR and 120 underwent c-MVR. Evaluated parameters included operative time, cardiopulmonary bypass (CPB) and cross-clamp times, extubation time, ICU and hospital stay, chest drainage, mechanical ventilation duration, postoperative pain scores, complications, and 30-day mortality.

Patients in the r-MVR group showed significantly better short-term outcomes. Postoperative drainage was lower (323 ± 154 mL vs. 532 ± 320 mL), red blood cell transfusion was reduced (0.8 ± 0.9 vs. 2.3 ± 2.4 units), and intubation time was shorter (10.2 ± 6.2 vs. 17.7 ± 21.3 h) compared to the c-MVR group (p < 0.001). Additionally, hospital stay (6.8 ± 3.7 vs. 9.4 ± 4.7 days) and pain scores (2.4 ± 0.85 vs. 3.5 ± 0.96) were significantly improved in the robotic group. However, CPB and cross-clamp times were longer in r-MVR (168 ± 47 vs. 104 ± 31 min and 106 ± 34 vs. 69 ± 21 min, respectively; p < 0.001). Complication and 30-day mortality rates were similar between groups.

Robotic-assisted mitral valve replacement is a safe and effective alternative to conventional surgery in RMVD. Despite longer operative times, it offers better early recovery and may be preferred in experienced centers for selected patients.