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.date.updated

2021-05-06T14:23:48Z

dc.description.abstract

Background

Port-access (PORT) and robotic (ROBO) mitral repair are well established, but differences in patient selection and outcomes are not well documented.

Methods

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.

Results

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.

Conclusions

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.identifier.issn

0886-0440

dc.identifier.issn

1540-8191

dc.identifier.uri

https://hdl.handle.net/10161/22843

dc.language

eng

dc.publisher

Hindawi Limited

dc.relation.ispartof

Journal of cardiac surgery

dc.relation.isversionof

10.1111/jocs.15342

dc.subject

minimally-invasive

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mitral repair

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robotics

dc.title

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

dc.type

Journal article

duke.contributor.orcid

Loungani, Rahul S|0000-0002-5431-5732

pubs.begin-page

1219

pubs.end-page

1225

pubs.issue

4

pubs.organisational-group

School of Medicine

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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

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