Paul Subroto, Isaacs Abby J, Jalbert Jessica, Osakwe Nonso C, Salemi Arash, Girardi Leonard N, Sedrakyan Art
Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York.
Department of Health Policy and Research, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York.
Ann Thorac Surg. 2015 May;99(5):1546-53. doi: 10.1016/j.athoracsur.2014.12.043. Epub 2015 Mar 7.
Robotic-assisted mitral valve repair is becoming more frequently performed in cardiac surgery. However, little is known about its utilization and safety at a national level.
Patients undergoing mitral valve repair in the United States from 2008 to 2012 were identified in the National Inpatient Sample. Inhospital mortality, complications, length of stay, and cost for patients undergoing robotic-assisted mitral valve repair were compared with patients undergoing nonrobotic procedures.
We identified 50,408 isolated mitral valve repair surgeries, of which 3,145 were done with robotic assistance. In a propensity score matched analysis of 631 pairs of patients, we found no difference between patients undergoing robotic-assisted and nonrobotic-assisted mitral valve repair with respect to inhospital mortality, complications, or composite outcomes in unadjusted or multivariable analyses. Robotic-assisted mitral valve repair surgery was associated with a shorter median length of stay (4 versus 6 days, p < 0.001), and there was no difference in median total costs between the two procedures.
In our analysis of a large national database with its inherent limitations, robotic-assisted mitral valve repair was found to be safe, with an acceptable morbidity and mortality profile.
机器人辅助二尖瓣修复术在心脏外科手术中的应用越来越频繁。然而,在全国范围内,对其使用情况和安全性了解甚少。
在国家住院患者样本中识别出2008年至2012年在美国接受二尖瓣修复术的患者。将接受机器人辅助二尖瓣修复术的患者的住院死亡率、并发症、住院时间和费用与接受非机器人手术的患者进行比较。
我们识别出50408例单纯二尖瓣修复手术,其中3145例是在机器人辅助下完成的。在对631对患者进行的倾向评分匹配分析中,我们发现在未调整或多变量分析中,接受机器人辅助和非机器人辅助二尖瓣修复术的患者在住院死亡率、并发症或综合结局方面没有差异。机器人辅助二尖瓣修复手术的中位住院时间较短(4天对6天,p<0.001),两种手术的中位总费用没有差异。
在我们对一个存在固有局限性的大型国家数据库的分析中,发现机器人辅助二尖瓣修复术是安全的,其发病率和死亡率情况可以接受。