Comparison of robotic and anterolateral minithoracotomy mitral valve repair: Experience in China

Nonsternotomy mitral valve repair is a popular treatment for degenerative mitral regurgitation. Data on the safety and effectiveness of anterolateral minithoracotomy and robotic mini-invasive mitral valve repair are lacking in China. This study compared the safety and efficacy of robotic mini-invasive and nonrobotic minithoracotomy mitral valve repair using a retrospective cohort study.

We included 348 patients with degenerative mitral regurgitation who underwent robotic mini-invasive (n = 200) or anterolateral minithoracotomy mitral valve repair (n = 148) between June 2014 and January 2023. Relationships between surgical approach, surgical characteristics, and outcomes were evaluated using linear and logistic regression.

Among 348 patients who underwent mitral valve repair, mean age was 50.69 ± 14.13 years (63.2% men). Compared with anterolateral minithoracotomy repair, robotic mini-invasive repair had a shorter intensive care unit stay (β = -17.16; 95% confidence interval [CI], -34.18, -0.15; P = .049) but longer surgery duration (β = 0.41; 95% CI, 0.08-0.74; P = .014) and had 50% decreased risk of red blood cell use (odds ratio, 0.50; 95% CI, 0.32-0.81; P = .004) and 71% of plasma use (odds ratio, 0.29; 95% CI, 0.17-0.49; P < .001). Surgical approach was not associated with complications or heart-related outcomes during follow-up. Robotic mini-invasive mitral valve repair cost was 175,343.1 (158,300.4-191,835.0) Ren Min Bi (Chinese currency); anterolateral minithoracotomy repair cost was 141,065.0 (125,796.7-175,575.5) Ren Min Bi (P < .001).

Robotic mini-invasive mitral valve repair possesses distinctive advantages and demonstrated equivalent and stable clinical efficacy compared with anterolateral minithoracotomy repair. Although not widely used in China, this approach may improve medical resource use.