Robotic mitral valve repair linked to benefits for elderly patients
Robotic mitral valve repair is associated with shorter hospitalizations for elderly patients compared to procedures that require a traditional sternotomy, according to new research published in The Annals of Thoracic Surgery.[1]
“Degenerative mitral valve disease is one of the most common causes of mitral valve regurgitation (MR) in the Western world, and it has an increased prevalence in elderly patients,” wrote first author Tedy Sawma, MD, a cardiac surgery fellow with Mayo Clinic, and colleagues. “Operative repair is the treatment of choice that can prevent the serious sequelae of heart failure related to chronic severe MR and premature death. With increased experience, mitral valve repair with robotic assistance has been extended to a broad spectrum of patients, including the elderly.”
Sawma et al. reviewed data from more than 600 patients 65 years old or older who underwent isolated mitral valve repair for the first time using either a robotic approach or a standard median sternotomy at the same high-volume facility. Propensity score matching helped the group focus on 189 matched patients with similar baseline characteristics. The median age for this group was 70 years old, 33.1% were women and all patients presented with severe MR.
Overall, operative mortality was just 0.3% among the matched patients. The median perfusion and cross-clamp times were 80 minutes and 54 minutes, respectively, for the robotic patients and 52 minutes and 38 minutes, respectively, for the sternotomy patients.
In addition, 21% of patients from the robotic group required intraoperative and postoperative blood transfusions compared to 32% of patients from the sternotomy group. The robotic group was also linked to a lower rate of new-onset atrial fibrillation, shorter ICU stays and shorter hospitalizations.
Stroke rates and the odds of going home after discharge were similar between the two groups, the authors added.
Sawma and colleagues also reviewed echocardiography data, noting that recurrent and residual MR “was relatively uncommon” for both treatment approaches and reintervention rates were quite low.
“Durability of surgical repair of MR is particularly important in the era of transcatheter technologies such as the MitraClip,” the authors wrote.
Also, the mean survival rates for all patients after 3, 5 and 10 years were 98%, 95% and 92%, respectively. The group did not identify any significant differences between the two treatment techniques when it came to survival or post-treatment quality of life.
“The proven safety and durability of surgical mitral valve repair have shaped management guidelines for asymptomatic patients with severe MR,” the authors concluded. “However, in clinical practice, many clinicians adopt a conservative approach regarding surgical referral of elderly patients with MR, particularly those with no or minimal symptoms and adequate physical activity. Robotic mitral valve repair offers a unique advantage for appropriately selected older patients by minimizing the physical impact of surgical incision and, as demonstrated in this study, yielding equivalent survival, repair durability, and functional results as seen in patients having mitral valve repair by standard sternotomy.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.