Robotic Mitral Valve Repair for Simple and Complex Degenerative Disease: Mid-Term Clinical and Echocardiographic Quality Outcomes
Background—Severe primary (degenerative) mitral valve regurgitation (MR) is repaired with durable results when "simple" single scallop disease is addressed. The mid-term quality outcomes of minimally invasive repair for "complex disease" are unknown however.
Methods and Results—From January 2008 to January 2015, 487 patients (56±11 years, 360 men, ejection fraction 65±6%, 98.8% complete follow-up) underwent robotic mitral valve repair for severe non-ischemic degenerative MR. Simple pathology was addressed in 289/487 (59%) and complex repair (all others) was performed in 198/487 (41%). Four patients died during follow-up with a 5-year survival rate 99.5% (99.4% simple; 99.5% complex, HR=0.48, 95% CI 0.05-4.59); and NYHA functional class I/II was documented in 97.9%(477/487). Eight patients had recurrence of ≥moderate MR, (4 simple, 4 complex), with a 5 year freedom from MR of 94.6% (96.2% simple; 92.7%, complex, p=0.67; HR=1.36, 95% CI 0.34-5.43). Seven patients (2 simple, 5 complex), underwent mitral reoperation, with a 5-year freedom from reoperation of 97.7% (99.2% simple and 95.7% complex, p=0.13; HR=3.35, 95% CI 0.65-17.32).
Conclusions—At a large tertiary care referral center, mid-term quality outcomes after robotic correction of degenerative MR are excellent, with very high survival, infrequent complications and a low likelihood of MR recurrence - regardless of mitral valve repair complexity. Awareness of these improvements in outcome is important to inform contemporary decisions regarding high-quality alternatives to conventional and percutaneous mitral repair.
- Received June 4, 2015.
- Revision received September 22, 2015.
- Accepted October 2, 2015.