Document resource
Background A near 100% repair rate has been reported for sternotomy mitral valve procedures by some reference centres but there is concern that minimally invasive and robotic mitral valve surgery may be associated with a lower repair rate due to its greater procedural complexity and therefore potential loss of patient survival. This may be emphasized during the learning curve which is recognised to be 75-125 cases.Methods From January 2011 to December 2024, 597 consecutive patients underwent minimally invasive (n=541) or robotic mitral valve surgery (n=56) by a single surgeon (median age, 62 years [IQR 54-70]; 31.3% female; elective [n=553, 93.3%], reoperations [n=44, 7.4%]). Moderate or poor LV function was present in 71 (11.9%), and moderate or severe pulmonary hypertension in 316 (51.8%).Results Aetiology was degenerative (n=478 [Barlows, n=202; FED, n=276]), rheumatic (n=30), other (endocarditis, ischemic, congenital) (n=60), atrial secondary MR (n=29). All the robotic patients had degenerative disease. In the mini mitral cohort, median cardiopulmonary bypass (CPB) and cross clamp (XC) times were 188 mins (164-214) and 124 mins (105-146), with 133 concomitant procedures (cryomaze [n=112, 20.2%], TV repair [n=21, 3.8%]). Twelve patients (2.2%) returned to the OR for bleeding. In-hospital mortality was 0.5% (n=3). The repair rate for degenerative disease was 96.7% (406/422) including the learning curve with ten-year survival of 90% (see figure 1).In the robotic cohort, operative times were significantly longer reflecting the learning curve, but post-operative ICU and hospital stay were shorter (24h [IQR 20,42] vs 45h [IQR 23, 70], p<0.001; 4 days [IQR 4,5] vs 6 days [IQR 5, 8], p<0.001,respectively). No patients were either converted to sternotomy or returned to the OR for bleeding, in-hospital mortality was 0% versus predicted 0.8% (IQR 0.6-0.9) and the repair rate was 100% (56/56). Five-year survival was 98%. One patient developed mild-moderate recurrent MR during follow up in the robotic cohort.The freedom from reoperation at 10 years for degenerative disease independent of surgical approach was 97.5%, with 96% freedom from ≥2+ MR.Conclusions Near 100% repair rates can be achieved for both minimally invasive and robotic mitral valve surgery even during the learning curve. These should be considered as an alternative to sternotomy in future guidelines.Abstract 267 Figure 1Survival, stratified by pathology (n = 537)