Robotic mitral valve repair in octogenarians: safety and clinical outcomes compared with younger patients

Robotic mitral valve (MV) repair has evolved as a minimally invasive surgical approach for mitral regurgitation (MR). However, evidence regarding its safety and clinical outcomes in octogenarians remains limited. This study was performed to evaluate the feasibility and early outcomes of robotic MV repair in octogenarians compared with younger patients.

We retrospectively reviewed consecutive patients who underwent totally endoscopic robotic MV repair for MR between September 2019 and September 2024 at Osaka Metropolitan University Graduate School of Medicine. Both degenerative and functional MR were included. Patients were divided into two groups according to age: octogenarians (≥80 years) and younger patients (≤65 years). Preoperative characteristics, operative findings, and postoperative outcomes were compared. Postoperative physical function in older patients was evaluated using the Short Physical Performance Battery (SPPB).

Among 170 robotic MV repair cases, 16 patients were aged ≥80 years and 101 patients were aged ≤65 years. Older patients had a higher prevalence of hypertension [14 (88%) vs. 51 (50%); P=0.006], dyslipidemia [6 (38%) vs. 14 (14%); P=0.03], respiratory disorders [4 (25%) vs. 2 (2%); P=0.003], and atrial fibrillation [9 (56%) vs. 13 (13%); P<0.001]. Preoperative echocardiography showed severe MR in all patients, and 10 older patients (63%) had more than moderate tricuspid regurgitation (TR). Concomitant procedures, including tricuspid valve repair [7 (44%) vs. 10 (10%); P=0.002], Maze procedure [7 (44%) vs. 10 (10%); P=0.002] and left atrial appendage closure [8 (50%) vs. 9 (9%); P<0.001], were performed more frequently in octogenarians. Echocardiography at 1 week after surgery and at the 1-year follow-up showed that MR and TR were reduced to no more than mild in all older patients. Comparison of preoperative and postoperative SPPB scores showed no significant differences in any component (balance, gait speed, or chair stand), and all older patients were discharged home without major complications.

Robotic MV repair in carefully selected octogenarians was feasible and associated with favorable early clinical outcomes. Concomitant procedures could be safely performed without deterioration of postoperative physical performance. Robotic MV surgery may represent a reasonable treatment option for older patients.