Kobayashi Kei, Guo Yizhan, Rubino Thomas E, Ramirez Luis E, Waterford Stephen D, Sultan Ibrahim, Morell Victor D, Bonatti Johannes
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and UPMC Heart and Vascular Institute, Pittsburgh, PA, USA.
Interdiscip Cardiovasc Thorac Surg. 2024 Nov 6;39(5). doi: 10.1093/icvts/ivae182.
To evaluate the feasibility, safety and quality of robotic-assisted mitral valve repair in complex versus non-complex cases during the early phase of a programme.
Since the programme launch in September 2021 until February 2024, 100 patients underwent robotic-assisted mitral valve repair. Of them, 21 patients had complex repairs, while 79 had non-complex repairs. The median age was 58 years for complex cases and 61 years for non-complex cases (P = 0.36).
Bileaflet prolapse was significantly more prevalent in the complex group (52.4% vs 12.7%, P < 0.001). Neochord placement (61.9% vs 13.9%, P < 0.001) and commissuroplasty (28.6% vs 5.1%, P = 0.005) were more frequent in the complex group. The complex group had longer cardiopulmonary bypass times (161 vs 141 min, P < 0.001), aortic cross-clamp times (123 vs 102 min, P < 0.001) and leaflet repair times (43 vs 24 min, P < 0.001). Second pump runs were required more often for complex cases (23.8% vs 3.8%, P = 0.01). All patients left the operating room with residual mitral regurgitation of mild or less. Fewer complex patients were extubated in the operating room (42.9% vs 70.9%, P = 0.02), yet hospital stay was similar (4 vs 4 days, P = 0.56). There were no significant differences in postoperative adverse events. There were no differences in mitral regurgitation of mild or less 4 weeks post-surgery (95.2% vs 98.7%, P = 0.47).
Complex mitral valve repair can be safely and effectively performed with robotic assistance, even in the early phase of a programme. Despite longer operative and ventilation times in the complex group, hospital stay and postoperative adverse events remained similar.
在一项计划的早期阶段，评估机器人辅助二尖瓣修复术在复杂病例与非复杂病例中的可行性、安全性和质量。
自2021年9月该计划启动至2024年2月，100例患者接受了机器人辅助二尖瓣修复术。其中，21例患者进行了复杂修复，79例进行了非复杂修复。复杂病例的中位年龄为58岁，非复杂病例为61岁（P = 0.36）。
双叶脱垂在复杂组中更为常见（52.4% 对12.7%，P < 0.001）。复杂组新腱索置入（61.9% 对13.9%，P < 0.001）和瓣叶交界成形术（28.6% 对5.1%，P = 0.005）更为频繁。复杂组的体外循环时间更长（161对141分钟，P < 0.001）、主动脉阻断时间更长（123对102分钟，P < 0.001）和瓣叶修复时间更长（43对24分钟，P < 0.001）。复杂病例更常需要二次转机（23.8% 对3.8%，P = 0.01）。所有患者离开手术室时二尖瓣反流均为轻度或更低程度。复杂组在手术室拔管的患者较少（42.9% 对70.9%，P = 0.02），但住院时间相似（4天对4天，P = 0.56）。术后不良事件无显著差异。术后4周轻度或更低程度二尖瓣反流无差异（95.2% 对98.7%，P = 0.47）。
即使在计划的早期阶段，机器人辅助下也可安全有效地进行复杂二尖瓣修复术。尽管复杂组手术和通气时间更长，但住院时间和术后不良事件仍相似。
