Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.
J Card Surg. 2022 Oct;37(10):3267-3275. doi: 10.1111/jocs.16849. Epub 2022 Aug 21.
Minimally invasive mitral valve repair (MVr) is commonly performed. Data on the outcomes of robotic MVr versus nonrobotic minimally invasive MVr are lacking. We sought to compare the short-term and mid-term outcomes of robotic and nonrobotic MVr.
We reviewed all patients who underwent robotic MVr (n = 424) or nonrobotic MVr via right mini-thoracotomy (n = 86) at Mayo Clinic, Rochester, MN, from January 2015 to February 2020. Data on baseline and operative characteristics, operative and long-term outcomes were analyzed. Patients were matched 1:1 using propensity scores.
Sixty-nine matched pairs were included in the study. The median age was 59 years (interquartile range [IQR]: 54-69) and 75% (n = 103) were male. Baseline characteristics were similar after matching. Robotic and nonrobotic MVr had similar operative characteristics, except that robotic had longer cross-clamp times (57 [48-67] vs. 47 [37-58] min, p < .001) and more P2 resections (83% vs. 68%, p = .05) compared to nonrobotic MVr. There was no difference in operative outcomes between groups. Hospital stay was shorter after robotic MVr (4 [3-4] vs. 4 [4-6] days, p = .003). After a median follow-up of 3.3 years (IQR, 2.1-4.5), there was no mortality in either group, and there was no difference in freedom from mitral valve reoperations between robotic and nonrobotic MVr (5 years: 97.1% vs. 95.7%, p = .63). Follow-up echocardiogram analysis predicted excellent freedom from recurrent moderate-or-severe mitral regurgitation at 3 years after robotic and nonrobotic MVr (90% vs. 92%, p = .18, respectively).
Both short-term and mid-term outcomes of robotic and nonrobotic minimally invasive mitral repair surgery are comparable.
微创二尖瓣修复术（MVr）已广泛开展。目前机器人辅助二尖瓣修复术（robotic MVr）与非机器人微创二尖瓣修复术（nonrobotic minimally invasive MVr）的临床结局数据尚缺乏。本研究旨在比较机器人辅助二尖瓣修复术与非机器人微创二尖瓣修复术的短期和中期临床结局。
我们回顾性分析了 2015 年 1 月至 2020 年 2 月期间，在明尼苏达州罗切斯特市梅奥诊所接受机器人二尖瓣修复术（n=424）或经右胸小切口非机器人微创二尖瓣修复术（n=86）的所有患者的临床资料。分析了基线和手术特征、手术和长期结局。采用倾向评分对患者进行 1:1 匹配。
共纳入 69 对匹配患者。患者中位年龄为 59 岁（四分位距 [IQR]：54-69 岁），75%（n=103）为男性。匹配后两组基线特征相似。机器人辅助二尖瓣修复术与非机器人微创二尖瓣修复术的手术特点相似，不同之处在于机器人辅助二尖瓣修复术的体外循环时间更长[57（48-67）min 比 47（37-58）min，p<0.001]，行 P2 切开术的比例更高[83%比 68%，p=0.05]。两组患者的手术结局相似。机器人辅助二尖瓣修复术患者的住院时间更短[4（3-4）d 比 4（4-6）d，p=0.003]。中位随访 3.3 年（IQR：2.1-4.5 年）后，两组均无死亡病例，机器人辅助二尖瓣修复术与非机器人微创二尖瓣修复术患者二尖瓣再手术率也无差异（5 年：97.1%比 95.7%，p=0.63）。超声心动图随访分析预测，机器人辅助二尖瓣修复术与非机器人微创二尖瓣修复术患者术后 3 年时，中重度二尖瓣反流复发率均有较好的无复发率（分别为 90%比 92%，p=0.18）。
机器人辅助二尖瓣修复术与非机器人微创二尖瓣修复术的短期和中期临床结局相当。
