The Sackler Faculty of Medicine, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel.
Duke University Medical Center, Box 3851, Durham, NC, 27710, USA.
J Robot Surg. 2022 Feb;16(1):199-206. doi: 10.1007/s11701-021-01214-7. Epub 2021 Mar 24.
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.
这项研究回顾了 2011 年至 2019 年期间在一家机构接受机器人辅助二尖瓣修复的 133 名患者的所有资料。机器人二尖瓣修复的平均年容量为 16 ± 7 例，而机构二尖瓣修复的总年容量为 116 ± 16 例。平均年龄为 58 ± 12 岁，77%为男性，二尖瓣病因是脱垂占 90%。合并症少见，房颤占 20%，中度三尖瓣反流占 14%。97%采用升主动脉插管，5%同期行三尖瓣手术，14%同期行迷宫手术。平均夹闭时间、泵时间和住院时间分别为 146 分钟、265 分钟和 5 天，但经验并未改善这些指标。无死亡或中风病例。5 年时，中度二尖瓣反流的累积发生率为 18 ± 6%（脱垂患者为 11 ± 5%），重度反流为 4 ± 3%，二尖瓣置换为 9 ± 5%（脱垂患者为 5 ± 3%）。5 年生存率为 96 ± 3%。在二尖瓣修复量较大的中心，每年进行 16 例机器人二尖瓣手术可以获得良好的临床效果，持续 5 年。每年 16 例的手术量不足以随着时间的推移改善泵时间或住院时间。
