Robotic Mitral Valve Repair in Older Individuals: An Analysis of The Society of Thoracic Surgeons Database.

Abstract

Background

National outcomes of robotic mitral valve repair (rMVr) compared with sternotomy (sMVr) in older patients are currently unknown.

Methods

From 2011 to 2014, all patients aged 65 years and older undergoing MVr in The Society of Thoracic Surgeons Adult Cardiac Surgery Database linked to Medicare claims data were identified. Patients who underwent rMVr were propensity matched to patients who underwent sMVr. Standard differences and falsification outcome of baseline characteristics were tested to ensure a balanced match. Cox models were used to calculate 3-year mortality, heart failure readmission, and mitral valve reintervention, adjusting for competing risks where appropriate.

Results

After matching, 503 rMVr patients from 65 centers and 503 sMVr from 251 centers were included. There were no significant differences in comorbidities or falsification outcome. Cardiopulmonary bypass and cross-clamp times were longer with rMVr versus sMVr at 125 versus 102 minutes (p < 0.0001) and 85 versus 75 minutes (p < 0.0001), respectively. The rMVr patients had shorter intensive care unit (27 vs 47 hours, p < 0.0001) and hospital stay (5 vs 6 days, p < 0.0001), less frequent transfusion (21% vs 35%, p < 0.0001), and less atrial fibrillation (28% vs 40%, p < 0.0001). Three-year mortality (hazard ratio, 1.21; 95% confidence interval, 0.68 to 2.16; p = 0.52), heart failure readmission (hazard ratio, 1.42; 95% confidence interval, 0.80 to 2.52, p = 0.10), and mitral valve reintervention (hazard ratio, 0.42; 95% confidence interval, 0.15 to 1.18; p = 0.22) did not differ between the groups.

Conclusions

The rMVr procedure was associated with less atrial fibrillation, less frequent transfusion requirement, and shorter intensive care unit and hospital stay, without a significant difference in 3-year mortality, heart failure readmission, or mitral valve reintervention. In older patients, rMVr confers short-term advantages without a detriment to midterm outcomes.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.athoracsur.2018.05.074

Publication Info

Wang, Alice, J Matthew Brennan, Shuaiqi Zhang, Sin-Ho Jung, Babatunde Yerokun, Morgan L Cox, Jeffrey P Jacobs, Vinay Badhwar, et al. (2018). Robotic Mitral Valve Repair in Older Individuals: An Analysis of The Society of Thoracic Surgeons Database. The Annals of thoracic surgery, 106(5). pp. 1388–1393. 10.1016/j.athoracsur.2018.05.074 Retrieved from https://hdl.handle.net/10161/22846.

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Scholars@Duke

Brennan

J. Matthew Brennan

Associate Professor of Medicine

Dr. Brennan is an Interventional Cardiologist at Duke University Medical Center, with an interest in both Coronary and Valvular Heart Disease. 

Jung

Sin-Ho Jung

Professor of Biostatistics & Bioinformatics

Design of Clinical Trials
Survival Analysis
Longitudinal Data Analysis
Clustered Data Analysis
ROC Curve Analysis
Design and Analysis of Microarray Studies
Big Data Analysis

Glower

Donald D. Glower

Professor of Surgery

Current clinical research projects examine the effects of patient characteristics and surgical technique in outcome after minimally invasive cardiac surgery, valve repair and replacement, and coronary artery bypass grafting.
Prior work has examined the role of surgical therapy versus medical therapy in aortic dissection, load-independent means to quantify left and right ventricular function, and management of complex coronary disease.


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