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Robotic versus port-access mitral repair: A propensity score analysis.

Publication ,  Journal Article
Barac, YD; Loungani, RS; Sabulsky, R; Zwischenberger, B; Gaca, J; Carr, K; Glower, DD
Published in: J Card Surg
April 2021

BACKGROUND: Port-access (PORT) and robotic (ROBO) mitral repair are well established, but differences in patient selection and outcomes are not well documented. METHODS: A retrospective analysis was performed on 129 ROBO and 628 PORT mitral repairs at one institution. ROBO patients had 4 cm nonrib spreading incisions with robotic assistance, while PORT patients had 6-8 cm rib spreading incisions with thoracoscopic assistance. Propensity score analysis matched patients for differences in baseline characteristics. RESULTS: Unmatched ROBO patients were younger (58 ± 11 vs. 61 ± 13, p = .05), had a higher percentage of males (77% vs. 63%, p = .003) and had less NYHA Class 3-4 symptoms (11% vs. 21%, p < .01), less atrial fibrillation (19% vs. 29%, p = .02) and less tricuspid regurgitation (14% vs. 24%, p = .01). Propensity score analysis of matched patients showed that pump time (275 ± 57 vs. 207 ± 55, p < .0001) and clamp time (152 ± 38 vs. 130 ± 34, p < .0001) were longer for ROBO patients. However, length of stay, postoperative morbidity, and 5-year survival (97 ± 1% vs. 96 ± 3%, p = .7) were not different. For matched patients with degenerative valve disease, 5-year incidence of mitral reoperation (3 ± 2% vs. 1 ± 1%), severe mitral regurgitation (MR) (6 ± 4% vs. 1 ± 1%), or ≥2 + MR (12 ± 5% vs. 12 ± 4%), were not significantly different between ROBO versus PORT approaches. Predictors of recurrent moderate MR were connective tissue disease, functional etiology, and non-White race, but not surgical approach. CONCLUSIONS: In this first comparison out to 5 years, robotic versus port-access approach to mitral repair had longer pump and clamp times. Perioperative morbidity, 5-year survival, and 5-year repair durability were otherwise similar.

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Published In

J Card Surg

DOI

EISSN

1540-8191

Publication Date

April 2021

Volume

36

Issue

4

Start / End Page

1219 / 1225

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Robotic Surgical Procedures
  • Retrospective Studies
  • Propensity Score
  • Mitral Valve Insufficiency
  • Mitral Valve
  • Middle Aged
  • Male
  • Humans
  • Female
 

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Barac, Y. D., Loungani, R. S., Sabulsky, R., Zwischenberger, B., Gaca, J., Carr, K., & Glower, D. D. (2021). Robotic versus port-access mitral repair: A propensity score analysis. J Card Surg, 36(4), 1219–1225. https://doi.org/10.1111/jocs.15342
Barac, Yaron D., Rahul S. Loungani, Richard Sabulsky, Brittany Zwischenberger, Jeffrey Gaca, Keith Carr, and Donald D. Glower. “Robotic versus port-access mitral repair: A propensity score analysis.J Card Surg 36, no. 4 (April 2021): 1219–25. https://doi.org/10.1111/jocs.15342.
Barac YD, Loungani RS, Sabulsky R, Zwischenberger B, Gaca J, Carr K, et al. Robotic versus port-access mitral repair: A propensity score analysis. J Card Surg. 2021 Apr;36(4):1219–25.
Barac, Yaron D., et al. “Robotic versus port-access mitral repair: A propensity score analysis.J Card Surg, vol. 36, no. 4, Apr. 2021, pp. 1219–25. Pubmed, doi:10.1111/jocs.15342.
Barac YD, Loungani RS, Sabulsky R, Zwischenberger B, Gaca J, Carr K, Glower DD. Robotic versus port-access mitral repair: A propensity score analysis. J Card Surg. 2021 Apr;36(4):1219–1225.
Journal cover image

Published In

J Card Surg

DOI

EISSN

1540-8191

Publication Date

April 2021

Volume

36

Issue

4

Start / End Page

1219 / 1225

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Robotic Surgical Procedures
  • Retrospective Studies
  • Propensity Score
  • Mitral Valve Insufficiency
  • Mitral Valve
  • Middle Aged
  • Male
  • Humans
  • Female