Outcomes following the first 100 cases of a new robotic mitral valve program.

BACKGROUND

Widespread adoption of robotic mitral surgery has been limited owing to challenges associated with initiating a robotic program. We report outcomes from the first 100 consecutive patients undergoing robotic mitral surgery at our institution.

METHODS

Data were collected retrospectively and analyzed for 100 consecutive patients who underwent robotic mitral valve surgery between March 2022 and February 2025. Categorical variables are reported as count and percentage; continuous data, as median and interquartile range (IQR).

RESULTS

The median patient age was 63.6 years (IQR, 55-71 years) and Society of Thoracic Surgeons-predicted mortality was 0.55% (range, 0.1%-9.2%). The median body mass index was 26 (IQR, 24-31), and 4% of the patients had a severe pectus deformity. Most patients had isolated posterior prolapse (67%), followed by bileaflet prolapse (27%) and isolated anterior prolapse (3%). Ten patients (10%) underwent 11 prior cardiac interventions, including coronary artery bypass grafting in 2, mitral valve repair/replacement in 5, atrial septal defect/patent foramen ovale repair in 2, mechanical root/ascending/hemi-arch in repair in 1, and mitral balloon valvuloplasty in 1. Cardiopulmonary bypass and aortic cross-clamp times were 172 (IQR, 138-202) minutes and 111 (IQR, 90-132) minutes, respectively. There were no sternotomy conversions or failed repair attempts in the last 40 cases. Of 92 attempted repairs, 91 (99%) were successful with mild or less mitral regurgitation. The median intensive care unit length of stay was 1.3 (IQR, 1-2) days, and the median hospital stay was 5.3 (IQR, 4-6) days, and there were no strokes, unplanned coronary interventions, or 30-day deaths.

CONCLUSIONS

Robotic mitral surgery can yield satisfactory outcomes early in a program's experience. High repair rates and low morbidity rates are attainable in patients with conventional relative contraindications to robotic approaches, including those with previous cardiac surgery, complex mitral valve pathology, and severe chest wall deformities.