Closed-Chest Robotic vs Port Access Approach for Mitral Repair: Comparison of Postoperative Outcomes.

BACKGROUND

A trocar-only approach has recently been proposed for mitral valve repair. This closed-chest robotic-assisted (CCR) mitral valve repair completely avoids minithoracotomy, thereby potentially enhancing surgical efficiency and maximizing the benefits of robotic technology. We aimed to compare this approach with the port-access approach.

METHODS

This study was a retrospective analysis of patients undergoing surgery using CCR or a port-access approach for isolated severe mitral regurgitation secondary to mitral prolapse (2012-2025). A 1:1 propensity-matched cohort was analyzed.

RESULTS

A total of 306 patients were included (CCR, 117; port-access, 189), with 107 matched pairs after propensity adjustment. Repair rates were 100% in both groups with no conversions. Operative mortality was negligible, and major complications were infrequent, including stroke (0.3%), prolonged mechanical ventilation (2%), acute kidney injury (1%), pacemaker implantation (2%), and reintervention for bleeding (3.2%), without group differences. The CCR approach showed shorter total operative, bypass, and cross-clamp times (-25, -18, and -21 minutes; P < 0.001). Postoperative outcomes favored CCR, with lower drainage output (145 mL vs 300 mL; P < .001), postoperative atrial fibrillation (11% vs 25%; P = .003), and infection rate (0% vs 5%; P = .017), as well as a shorter hospital stay (3 days vs 7 days; P < .001). Five patients (1 CCR and 4 port-access) required early repeat repair during the index admission as a result of suboptimal predischarge echocardiography; all patients underwent successful repairs using the same approach. Overall, 99.3% of patients were discharged with mild or less mitral regurgitation. At 2 years, freedom from severe regurgitation was 96% in the CCR group and 94% in the port-access group.

CONCLUSIONS

The CCR approach is a safe and effective alternative to the port-access approach for elective mitral valve repair. Prospective randomized studies are needed to define its clinical impact further.