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Meta-Analysis
. 2022 Nov-Dec;17(6):471-481.
doi: 10.1177/15569845221141488. Epub 2022 Dec 18.

A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair

Ali Fatehi Hassanabad  1 , Fernanda N I Nagase  2 , Ameen M Basha  1 , Fadi Hammal  3 , Devidas Menon  2 , William D T Kent  1 , Imtiaz S Ali  1 , Jeevan Nagendran  4 , Tania Stafinski  2
Affiliations
Meta-Analysis

A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair

Ali Fatehi Hassanabad et al. Innovations (Phila). 2022 Nov-Dec.

Abstract

Objective: Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy.

Methods: A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible.

Results: The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches.

Conclusions: Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.

Keywords: minimally invasive cardiac surgery; mitral valve repair; robot-assisted mitral valve repair; robotic surgery.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1.
Fig. 1.
PRISMA diagram.
Fig. 2.
Fig. 2.
Meta-analyses of conversion to conventional sternotomy from ROB versus RMT studies. CI, confidence interval; RMT, right minithoracotomy mitral valve repair; ROB, robot-assisted mitral valve repair.
Fig. 3.
Fig. 3.
Meta-analyses of safety outcomes from ROB versus CS studies. CI, confidence interval; CS, conventional sternotomy mitral valve repair; ROB, robot-assisted mitral valve repair.
Fig. 4.
Fig. 4.
Meta-analysis of reoperation for bleeding from ROB versus CS and ROB versus RMT studies. CI, confidence interval; CS, conventional sternotomy mitral valve repair; RMT, right minithoracotomy mitral valve repair; ROB, robot-assisted mitral valve repair.
Fig. 5.
Fig. 5.
Meta-analyses of 30-day mortality from ROB vs CS and ROB vs RMT studies. CI, confidence interval; CS, conventional sternotomy mitral valve repair; RMT, right minithoracotomy mitral valve repair; ROB, robot-assisted mitral valve repair.
See this image and copyright information in PMC

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