Robotic Mitral Valve Repair for Degenerative Mitral Valve Regurgitation: Is it for Everyone?
Historically, the standard approach for all mitral valve surgery has been the mediasternotomy. Although initially developed for cosmesis, minimally invasive techniques for mitral valve surgery use a limited right anterior thoracotomy with and without endoscopic techniques, which have resulted in outcomes comparable to the traditional mediasternotomy incision1,2.
Advances in robotic technology, including three dimensional visualization and improved dexterity have facilitated the introduction of robotic surgery for mitral valve repairs. In an FDA safety and efficacy trial in 2000 involving 20 patients, Nifong and co-workers used robotic technology to perform a wide spectrum of mitral valve repair procedures3. Although crossclamp and operative times were longer when compared to the conventional mediasternotomy approach, the morbidity and mortality was similar and the mean hospital length of stay (LOS) was only 4 days. A follow-up study involving 112 patients showed a 30-day mortality of 0.7% and no conversions to a mediasternotomy4. The mean hospital LOS was 5 days and the 5-year freedom from reoperation was 90%. More recent series using robotic techniques for mitral valve repairs have duplicated these excellent outcomes5,6. Although crossclamp, cardiopulmonary bypass, and total operative times are significantly longer, there are no differences in morbidity or mortality between robotic and non-robotic repairs. In general, robotic patients spend one less day in the hospital. Follow-up from 1-3 years show that > 90% of patients are free of moderate-to-severe mitral regurgitation (MR) and the need for another mitral valve procedure. However, despite the apparent cost savings of spending one less day in the hospital, Kam and co-workers could not demonstrate any differences in hospital expenses for patients undergoing robotic mitral repairs7. The decreased LOS appears to be offset by increased operation time. Furthermore, the cost of purchasing the robotic equipment, its maintenance and need for upgrades and supplies are usually not factored into most cost analyses.
- Received October 12, 2015.
- Accepted October 13, 2015.