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Sustained results of robotic mitral repair in a lower volume center with extensive minimally invasive mitral repair experience

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Abstract

The literature for robotic mitral repair is dominated by a small number of large volume institutions, and intermediate-term outcomes out to 5 years are rare. Whether and under what circumstances a lower volume institution could obtain durable outcomes is not known. A retrospective review was performed on all 133 patients undergoing robotically assisted mitral repair from 2011 to 2019 at a single institution. Mean volume of robotic mitral repair was 16 ± 7 cases per year, while mean institutional total volume of mitral repair was 116 ± 16 cases per year. Mean age was 58 ± 12 years, 77% were men, and mitral etiology was prolapse in 90%. Comorbidity was infrequent with atrial fibrillation in 20% and moderate tricuspid regurgitation in 14%. Central aortic cannulation was used in 97% with concurrent tricuspid operation in 5% and concurrent maze in 14%. Median clamp time, pump time, and length of stay were 146 min, 265 min, and 5 days, respectively, but none improved with experience. There were no deaths or stroke. At 5 years, the cumulative incidence of moderate mitral regurgitation was 18 ± 6% (prolapse patients 11 ± 5%), severe regurgitation 4 ± 3%, and mitral replacement 9 ± 5% (prolapse patients 5 ± 3%). 5-year survival was 96 ± 3%. At centers with significant mitral repair volume, a volume of 16 robotic mitral cases/year can yield good clinical outcomes durable out to 5 years. A case volume of 16 cases per year was not sufficient to improve pump time or length of stay over time.

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Availability of data

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

SAS 9.4, SAS Institute, Cary, NC

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Funding

No extramural funding was used to support this work.

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Authors and Affiliations

  1. The Sackler Faculty of Medicine, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel

    Yaron D. Barac

  2. Duke University Medical Center, Box 3851, Durham, NC, 27710, USA

    Rahul S. Loungani, Richard Sabulsky, Keith Carr, Brittany Zwischenberger & Donald D. Glower

Authors
  1. Yaron D. Barac
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  2. Rahul S. Loungani
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  3. Richard Sabulsky
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  4. Keith Carr
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  5. Brittany Zwischenberger
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  6. Donald D. Glower
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Contributions

YDB: design, drafting, revision, approval, data collection. RSL: design, revision, approval, data collection. RS: design, drafting, revision, approval. KC: revision, approval, data collection. BZ: design, data analysis, revision, approval. DDG: design, data analysis, drafting, revision, approval, statistics, data collection.

Corresponding author

Correspondence to Donald D. Glower.

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Conflict of interest

Yaron D. Barac, MD, PhD declares that he has no conflict of interest. Rahul S. Loungani, MD receives research support from Pfizer and Boston Scientific. Richard Sabulsky, MHA, PA-C, RN, BSN declares that he has no conflict of interest. Keith Carr, BS declares that he has no conflict of interest. Brittany Zwischenberger, MD declares that she has no conflict of interest. Donald D. Glower, MD declares that he has no conflict of interest.

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Pro00105921 6/22/20.

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Barac, Y.D., Loungani, R.S., Sabulsky, R. et al. Sustained results of robotic mitral repair in a lower volume center with extensive minimally invasive mitral repair experience. J Robotic Surg 16, 199–206 (2022). https://doi.org/10.1007/s11701-021-01214-7

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  • DOI: https://doi.org/10.1007/s11701-021-01214-7

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