Robotic Mitral Valve Repair in Patients With Thoracic Deformity

Robotic mitral valve repair (MVr) offers superior visualization and dexterity, potentially overcoming challenges in severe thoracic deformity such as pectus excavatum. This study compared surgical outcomes after MVr in patients with and without thoracic deformity and assessed the impact of thoracic deformity on operative times in robotic MVr.

We reviewed 359 patients undergoing robotic MVr for degenerative mitral regurgitation (2018-2022). Patients with a Haller index ≥3.25 categorized as the deformity group (Group D; n=35), and those with a Haller index <3.25 were in the non-deformity group (Group N; n=324). Group D was younger, but repair techniques and concomitant surgery were similar. In the results, there was no significant difference in operative time and aortic cross-clamp time (80±29 vs. 80±30 min; P=0.969) between the 2 groups. No correlation was found between thoracic dimensions and cross-clamp time. Early outcomes, including intensive care unit stay (1.92±1.59 vs. 1.77±1.26 days; P=0.519), hospital stay, mortality, stroke, and re-exploration, were comparable. Perioperative redo occurred in 4 patients in Group N (hemolysis from regurgitant jet, residual P2 prolapse, suture dehiscence) and 2 patients in Group D (systolic anterior motion-induced mitral regurgitation, poor posterior leaflet coaptation). One-year mitral regurgitation grade, survival, and freedom from reoperation were similar.

Among patients with thoracic deformity deemed suitable for robotic MVr, outcomes were not worse compared with patients without deformity.