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Robotic versus port-access mitral repair: A propensity score analysis.

dc.contributor.author Barac, Yaron D
dc.contributor.author Loungani, Rahul S
dc.contributor.author Sabulsky, Richard
dc.contributor.author Zwischenberger, Brittany
dc.contributor.author Gaca, Jeffrey
dc.contributor.author Carr, Keith
dc.contributor.author Glower, Donald D
dc.date.accessioned 2021-05-06T14:23:48Z
dc.date.available 2021-05-06T14:23:48Z
dc.date.issued 2021-04
dc.identifier.issn 0886-0440
dc.identifier.issn 1540-8191
dc.identifier.uri https://hdl.handle.net/10161/22843
dc.description.abstract <h4>Background</h4>Port-access (PORT) and robotic (ROBO) mitral repair are well established, but differences in patient selection and outcomes are not well documented.<h4>Methods</h4>A retrospective analysis was performed on 129 ROBO and 628 PORT mitral repairs at one institution. ROBO patients had 4 cm nonrib spreading incisions with robotic assistance, while PORT patients had 6-8 cm rib spreading incisions with thoracoscopic assistance. Propensity score analysis matched patients for differences in baseline characteristics.<h4>Results</h4>Unmatched ROBO patients were younger (58 ± 11 vs. 61 ± 13, p = .05), had a higher percentage of males (77% vs. 63%, p = .003) and had less NYHA Class 3-4 symptoms (11% vs. 21%, p < .01), less atrial fibrillation (19% vs. 29%, p = .02) and less tricuspid regurgitation (14% vs. 24%, p = .01). Propensity score analysis of matched patients showed that pump time (275 ± 57 vs. 207 ± 55, p < .0001) and clamp time (152 ± 38 vs. 130 ± 34, p < .0001) were longer for ROBO patients. However, length of stay, postoperative morbidity, and 5-year survival (97 ± 1% vs. 96 ± 3%, p = .7) were not different. For matched patients with degenerative valve disease, 5-year incidence of mitral reoperation (3 ± 2% vs. 1 ± 1%), severe mitral regurgitation (MR) (6 ± 4% vs. 1 ± 1%), or ≥2 + MR (12 ± 5% vs. 12 ± 4%), were not significantly different between ROBO versus PORT approaches. Predictors of recurrent moderate MR were connective tissue disease, functional etiology, and non-White race, but not surgical approach.<h4>Conclusions</h4>In this first comparison out to 5 years, robotic versus port-access approach to mitral repair had longer pump and clamp times. Perioperative morbidity, 5-year survival, and 5-year repair durability were otherwise similar.
dc.language eng
dc.publisher Wiley
dc.relation.ispartof Journal of cardiac surgery
dc.relation.isversionof 10.1111/jocs.15342
dc.subject minimally-invasive
dc.subject mitral repair
dc.subject robotics
dc.title Robotic versus port-access mitral repair: A propensity score analysis.
dc.type Journal article
duke.contributor.id Loungani, Rahul S|0799218
duke.contributor.id Zwischenberger, Brittany|0684436
duke.contributor.id Gaca, Jeffrey|0211383
duke.contributor.id Glower, Donald D|0117604
dc.date.updated 2021-05-06T14:23:48Z
pubs.begin-page 1219
pubs.end-page 1225
pubs.issue 4
pubs.organisational-group School of Medicine
pubs.organisational-group Surgery, Cardiovascular and Thoracic Surgery
pubs.organisational-group Duke
pubs.organisational-group Surgery
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Staff
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group Medicine
pubs.publication-status Published
pubs.volume 36
duke.contributor.orcid Loungani, Rahul S|0000-0002-5431-5732


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