Long-term mortality following robotic mitral valve repair

To compare long-term mortality between robotic and conventional mitral valve repair (MVr) for degenerative mitral regurgitation (DMR).

A retrospective analysis of Medicare data from 2012-2024 for patients who underwent surgical MVr for DMR was conducted. Patients with prior cardiac surgery were excluded. Two groups were created: robotic MVr and conventional MVr, which included both sternotomy and thoracotomy approaches. The primary outcome was 5-year mortality. Robotic and conventional cases were 1:2 propensity score matched for outcome assessment.

A total of 1502 cases of robotic MVr and 12,182 cases of conventional MVr were identified. The robotic approach represented a growing proportion of surgical MVr. Compared to patients who underwent conventional MVr, patients who underwent robotic MVr were younger and had a lower comorbid disease burden (P < .05 for both). Unadjusted mortality was lower following robotic MVr compared to conventional MVr at 30 days (0.93% vs 1.8%; P = .013), 1 year (2.4% vs 5.3%; P < .001), and 5 years (8.3% vs 15%; P < .001). Risk-adjusted mortality was similar in the 2 groups at 30 days (1.2% vs 0.98%; P = .48), 1 year (2.8% vs 3.1%; P = .72), and 5 years (8.8% vs 9.9%; P = .32) to conventional MVr. Hospital length of stay (mean, 6.2 ± 3.9 days vs 8.0 ± 5.0 days; P < .001) was shorter and rates of renal failure (6.8% vs 9.6%; P = .007) and permanent pacemaker implantation (2.0% vs 4.6%; P< .001) were lower following robotic MVr compared to conventional MVr.

Robotic MVr offered comparable long-term survival to conventional MVr in Medicare patients. These results support the use of robotic MVr for DMR for appropriately selected patients and skilled surgeons.