Robotic Mitral Valve Repair: A Decade of Experience With Echocardiographic Follow-up

Abstract

Background: Surgical approaches for mitral valve (MV) disease have evolved with the aim of developing minimally invasive techniques. Although the safety of robotic procedures has been documented, there are limited data on long-term echocardiographic follow-up. This review demonstrates outcomes of 11 years of robotic MV repair at a single, tertiary institution.

Methods: From 2008 to 2019, 843 patients underwent robotic MV repair at Mayo Clinic in Rochester, Minnesota. Repeated measures generalized least squares (GLS) modeling was used to assess the echocardiographic changes over time.

Results: The median age was 58 years (interquartile range, 50.8, 65.5 years), and 591 were male (70.1%). The mechanism of mitral regurgitation was posterior leaflet prolapse in 479 (56.8%) patients, bileaflet prolapse in 325 (38.6%), and anterior leaflet prolapse in 36 (4.3%). There were 3 early deaths (0.4%) and 24 early reoperations (2.8%). Echocardiographic follow-up demonstrated left ventricular end-systolic and end-diastolic dimensions, left atrial volume index, and pulmonary pressure all continuously improved up to 2 years postoperatively. Ejection fraction immediately declined postoperatively but then gradually improved to near normal over 2 years. Survival and freedom from reoperation at 10 years were 93% and 92.6%, respectively. When patients were surveyed after dismissal, 93.4% reported their activity level at or above their peers, and 93.3% reported no activity limitation from cardiac symptoms.

Conclusions: Robotic MV repair is safe and effective with excellent long-term results, including echocardiographic data that demonstrated early improvement in cardiac chamber size and maintenance of postoperative cardiac function. Exceedingly low mortality rates and freedom from reoperation are comparable to those of the standard open repair.