Hybrid robotic mitral valve surgery with staged percutaneous coronary intervention for degenerative mitral regurgitation and coronary artery disease.

OBJECTIVES

Some patients with degenerative mitral valve regurgitation have incidental coronary artery disease. When these patients are referred to our robotic cardiac surgery program, they are offered robotic mitral valve surgery combined with staged percutaneous coronary intervention performed during the same hospital admission. The objective of this study is to compare this new "hybrid" approach with the "conventional" operation consisting of sternotomy mitral valve surgery with coronary artery bypass grafting performed as a single procedure.

METHODS

Between 2011 and 2024, 181 consecutive patients with degenerative mitral valve regurgitation and coronary artery disease underwent hybrid robotic mitral valve surgery + percutaneous coronary intervention (n = 79) or conventional sternotomy mitral valve surgery + coronary artery bypass grafting (n = 102) at a single high-volume quaternary care center. Information was prospectively entered into Society of Thoracic Surgeons, regional, and institutional data collection instruments. Survival was obtained from a National Death Index.

RESULTS

Significant mitral annular calcification (requiring en bloc excision and patch reconstruction) was more frequent in the hybrid group (7.6% [6/79] vs 2.0% [2/102], P = .06). The repair rate was significantly higher in the hybrid group. Median aortic occlusion time was shorter in the hybrid group (90.0 vs 106.0 minutes, P = .01). In the hybrid group, 92.4% (73/79) of percutaneous coronary interventions were performed after robotic mitral valve surgery and 58.7% (44/75) involved a single coronary distribution only. In the conventional group, 53.9% (55/102) coronary artery bypass grafting surgeries consisted of 1 distal anastomosis. In the hybrid group, the median hospital length of stay was shorter by 2 days. The 30-day mortality and 5-year survival were excellent and identical in both groups.

CONCLUSIONS

For patients with degenerative mitral valve regurgitation and coronary artery disease, a hybrid approach (robotic mitral valve surgery + percutaneous coronary intervention) provided enhanced postoperative outcomes with short- and mid-term survival comparable to the conventional operation (sternotomy mitral valve surgery + coronary artery bypass grafting).