Robotic versus conventional sternotomy mitral valve surgery: a systematic review and meta-analysis

Abstract

Background: Robotic-assisted mitral valve surgery (RMVS) is becoming an increasingly performed procedure in cardiac surgery, however, its true safety and efficacy compared to the gold standard conventional sternotomy approach [conventional sternotomy mitral valve surgery (CSMVS)] remains debated. The aim of this meta-analysis was to provide a comprehensive analysis of all available literature comparing RMVS to CSMVS.Methods: An electronic search of five databases was performed to identify all relevant studies comparing RMVS to CSMVS. Pre-defined primary outcomes of interest included all-cause mortality, cerebrovascular accidents (CVA) and re-operation for bleeding. Secondary outcomes of interest included cross clamp time, cardiopulmonary bypass (CPB) time, intensive care unit (ICU) and hospital length of stay (LOS), postoperative atrial fibrillation (POAF) and red blood cell (RBC) transfusion.Results: The search strategy identified fourteen studies qualifying for inclusion in this meta-analysis comparing RMVS to CSMVS. The outcomes of 6,341 patients (2,804 RMVS and 3,537 CSMVS) were included. RMVS had significantly lower mortality when compared to CSMVS group in both the unmatched [odds ratio (OR) 0.33; 95% confidence interval (CI): 0.19-0.57; P<0.001] and matched cohorts (OR 0.35; 95% CI: 0.15-0.80; P=0.01). There was no significant difference in rates of CVA or re-operation for bleeding between the two groups in either the entire included cohort or matched patients. CSMVS had significantly shorter cross clamp time by 28 minutes (95% CI: 19.30-37.32; P<0.001) and CPB time by 49 minutes (95%

Systematic review and meta-analysis of mid-term survival, reoperation, and recurrent mitral regurgitation for robotic-assisted mitral valve repair

“…RMVr has been shown to be a safe procedure with acceptable outcomes by a number of dedicated, high-volume centers worldwide (17,30,31). Robotic mitral valve surgery has also been demonstrated to have comparable short-term outcomes to the gold standard conventional sternotomy and other minimally invasive surgical approaches to the mitral valve (9)(10)(11)32). However, worldwide uptake of RMVr has been slow with the main concerns being related to the steep learning curve/operative complexity and higher associated costs (33).…”

“…Robotic assisted mitral valve surgery facilitates surgery through smaller incisions with improved cosmesis, resulting in faster recovery, decreased pain and shorter hospital length of stay (8). In comparison to the gold standard surgical approach, conventional sternotomy, robotic mitral valve surgery has been shown to have lower incidences of postoperative atrial fibrillation, ventilation time, intensive care unit (ICU) stay and red blood cell (RBC) transfusion (9)(10)(11).…”

Propensity-matched analysis of robotic versus sternotomy approaches for mitral valve replacement

“…Furthermore, ICU stay time and post-operative LOS were statistically signi cantly shorter in the robot group. There are some complications that are inherent in perfusion and ventilation methods used for robotic surgery 5,9,17,18 . Possible major complications related to retrograde cardiopulmonary perfusion modalities include unilateral pulmonary edema and pneumonia, prolonged ventilation, and stroke.…”

“…4 After nearly three decades of development, robotic systems now have excellent threedimensional views, precise movements, and auxiliary equipment that can shorten the learning cycle for surgeons. 5 The feasibility and safety of robotic MVP has been proved in many studies, [6][7][8][9] with the primary goal of improving cosmetic results and reducing postoperative complications while maintaining the same prognosis as sternotomy surgery. However, the reports comparing robotic and sternotomy MVR are limited.…”

Is robotic assistance an added value in minimally invasive mitral valve surgery? A meta-analysis from propensity score–matched series

“…3,4 Nowadays, right-side chest approach with an en-face view of the valve requiring little septal retraction and minimizing distortion of the valve anatomy is established as a new standard for mitral valve surgery and the surgical community is far from the learning curve with this minimally invasive technique. 5,6 According to several meta-analyses, the advantages and drawbacks of both techniques versus standard sternotomy approach seem clear [7][8][9] : they are associated with prolonged operative times but they are beneficial in terms of reduced postoperative complications (atrial fibrillation, blood transfusion, wound infection), of reduced length of stay in intensive care unit (ICU) and in hospitalization. Therefore, the proponents of both approaches are arguing their utility for treating even the most complex mitral valve disease without any additional risk of potential complications despite prolonged operation times.…”