Wei Shixiong, Zhang Xin, Cui Huimin, Zhang Lin, Gong Zhiyun, Li Lianggang, Ren Tong, Gao Changqing, Jiang Shengli
Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China.
Cardiovasc Diagn Ther. 2020 Oct;10(5):1167-1174. doi: 10.21037/cdt-20-197.
To compare the clinical outcomes and hospital cost of robotic versus thoracoscopic approaches to mitral valve plasty (MVP).
We retrospectively analyzed patients who received minimal invasive MVP between 2007 January and 2020 January at our department. The basic characteristics, echocardiography, surgical data, postoperative adverse events and hospital cost of the patients were collected. The primary outcomes of this study were direct hospital cost and 30-day outcomes, including the operative time, complications, and length of hospital stay.
A total of 234 patients received minimally invasive MVP by using robotic (n=121) and thoracoscopic (n=113) technique respectively. The overall 30-day mortality rate was 0.9% (n=2), with no significant difference between two groups. The cardiopulmonary bypass time and aorta clamping time in thoracoscopic group were longer than that in robotic group (153.2±25.6 . 123.8±34.9 min and 111.8±23.0 . 84.9±24.3 min, P<0.001). The intraoperative blood transfusion rate (52.2% . 64.5%) and ICU time (2.8±2.3 . 3.6±2.7 days, all P<0.05) of the thoracoscopic group were lower than those in the robotic group. The adjusted hospital and operating room cost of the thoracoscopic group were significant lower ($18,208.4±$4,429.1 . $35,674.3±$4,936.1 and $9,038.3±$2,171.7 . $18,655.1±$2,558.3, all P<0.001).
Both robotic and thoracoscopic approach for MVP are safe and reliable. Robotic technique has shorter operation time, while thoracoscopic technique has more advantages in blood transfusion rate, postoperative ventilation time, ICU duration and hospitalization expenses.
比较机器人辅助与胸腔镜下二尖瓣成形术（MVP）的临床疗效和住院费用。
我们回顾性分析了2007年1月至2020年1月在我科接受微创MVP的患者。收集患者的基本特征、超声心动图、手术数据、术后不良事件和住院费用。本研究的主要结局是直接住院费用和30天结局，包括手术时间、并发症和住院时间。
共有234例患者分别采用机器人辅助技术（n = 121）和胸腔镜技术（n = 113）接受微创MVP。总体30天死亡率为0.9%（n = 2），两组之间无显著差异。胸腔镜组的体外循环时间和主动脉阻断时间长于机器人辅助组（153.2±25.6. 123.8±34.9分钟和111.8±23.0. 84.9±24.3分钟，P<0.001）。胸腔镜组的术中输血率（52.2%. 64.5%）和ICU时间（2.8±2.3. 3.6±2.7天，均P<0.05）低于机器人辅助组。胸腔镜组调整后的住院和手术室费用显著更低（18,208.4±4,429.1美元. 35,674.3±4,936.1美元和9,038.3±2,171.7美元. 18,655.1±2,558.3美元，均P<0.001）。
机器人辅助和胸腔镜下MVP方法均安全可靠。机器人技术手术时间较短，而胸腔镜技术在输血率、术后通气时间、ICU时长和住院费用方面更具优势。
