Robotic Totally Endoscopic Mitral Valve Surgery in Octogenarians: Age Is Just a Number!

Octogenarians are sometimes excluded from mitral valve (MV) surgery due to increased morbidity and mortality. Sternal-sparing approaches (e.g., robotic MV surgery) have the potential to reduce these risks. We reviewed the outcomes of robotic totally endoscopic MV surgery in octogenarians.

Of 600 patients undergoing elective robotic totally endoscopic MV surgery at our institution (September 2013 to December 2024), 40 patients were octogenarians. Early and midterm clinical and echocardiographic outcomes were analyzed. All procedures were performed using the da Vinci Si or Xi (Intuitive Surgical, Sunnyvale, CA, USA) with an endoscopic approach and an 8 to 10 mm working port.

The mean age was 83 ± 2.7 years, and 55% were female patients. The mean Society of Thoracic Surgeons risk was 4.4% ± 2.1%, 36 patients (90%) underwent MV repair, and 65% had concomitant procedures. Two patients had previous heart surgery. Cardiac arrest methods included endoballoon (62.5%), fibrillating heart (35%), or cross-clamp (2.5%). There was 1 (2.5%) conversion to sternotomy. The incidence of new postoperative atrial fibrillation was 15%, and 3 patients (7.5%) returned to the operating room for bleeding. There were no postoperative myocardial infarctions, strokes, or early mortalities. Mean intensive care unit and hospital length of stay were 1.5 ± 0.8 and 3.5 ± 1.5 days, respectively. Return to full activity occurred at a mean of 13 ± 9 days. Early postoperative echocardiography revealed 95% none to mild mitral regurgitation (MR). Clinical follow-up was complete in 100% of patients at a mean of 37 months. All-cause mortality occurred in 9 patients, and 1 was a cardiac-related death. At midterm echocardiography follow-up (mean 36 months), 90% had none to mild MR.

These findings add to the growing evidence supporting the safety and efficacy of robotic totally endoscopic MV surgery and specifically recognize its benefits in older patients.