What does the automated performance metric "console time" tell in robotically assisted mitral valve repair?

Console time is one of the automated performance metrics (APM) recorded by the robot software during robotic cardiac surgery. Little is known about what this APM predicts in cardiac surgery. This study aimed to evaluate factors associated with console time during robotically assisted mitral valve repair (raMVR). A total of 150 patients underwent raMVR from 7/2021 to 12/2024. Console time and related APMs were extracted from robotic system logs. Correlation analysis, multivariable linear regression, and multivariate analysis of variance (MANOVA) were used to assess associations between console time and pre-, intra-, and post-operative outcomes. Mean console time was 123.2 ± 47.0 min. Console time correlated with body mass index (r = 0.22, p = 0.01), cardiopulmonary bypass (CPB) time (r = 0.50, p < 0.001), aortic cross-clamp (ACC) time (r = 0.60, p < 0.001), and hospital stay (r = 0.24, p = 0.003). Console time was longer with bileaflet prolapse (p = 0.003), annular calcification (p = 0.01), leaflet calcification (p = 0.04), complex repair (p < 0.001), transfusion (p = 0.01) and reoperation for bleeding (p = 0.005). Multivariable regression identified decalcification (B = + 78.6 min, p < 0.001), ACC time (p < 0.001), CPB time (p = 0.02), leaflet resection combined with neochords (p = 0.01), and annular calcification (p = 0.03) as independent predictors. MANOVA showed console time tertiles were significantly associated with postoperative outcomes (Wilks' lambda = 0.86, p = 0.02). Patients in the lowest and middle tertile were more likely to be extubated in the operating room (p < 0.001). Console time reflects procedural complexity and operative intensity in raMVR. As an automated, objective metric, it may serve as a valuable tool for intra-operative assessment, surgical planning, and early outcome prediction in robotic cardiac programs.