Comparison Of Totally Endoscopic Robot Assisted Surgery And Minimally Invasive Surgery Via Right Thoracotomy In Mitral Valve Repair
Ryuta Seguchi
Newheart Watanabe Institute, Tokyo, Japan
Background: More than a decade has passed since the first Totally Endoscopic Robot-Assisted Mitral Valve Repair (TERMVR) was performed. Robot-Assisted surgical technique has developed and prevailed. Obviously, Totally Endoscopic Robot-Assisted Cardiac Surgery provides small wound and less pain compared to conventional surgery. However, some clinician questions its quality and safety in mitral valve surgery. Therefore, we performed a retrospective review and statistical analysis to examine whether TERMVR provides satisfying outcomes compared to conventional Minimally Invasive Mitral Valve Repair via Right Thoracotomy (MIMVR). Methods: From May 2014 to September 2019, 590 cases of repair for degenerative mitral valve regurgitation were performed in a single center. 353 cases were TERMVR and 237 cases were MIMVR. Outcomes of TERMVR and MIMVR were compared. Results: There were no difference in operation time (TERMVR 185±43 min vs MIMVR 190±41 min, p=0.15). Cardiopulmonary bypass (CPB) time was significantly longer in TERMVR (TERMVR 126±25 min vs MIMVR 113±30 min, p<0.03). Aortic cross clump time was significantly shorter in TERMVR (TERMVR 69±16 min vs MIMVR 75±23 min, p<0.03). Blood loss was significantly less in TERMVR (TERMVR 52±138 ml vs MIMVR 297±393ml, p<0.03). Percentage of transfusions required was significantly lower in TERMVR (TERMVR 7.6% vs MIMVR 27.8%, p<0.03). Reoperation for bleeding was required in 0.8% of TERMVR and 1.6% of MIMVR(p=0.35). Second cross clump for additional repair was required in 1.4% of TERMVR and 2.5% of MIMVR (p=0.35). Mortality was 0% in TERMVR and 0.4% in MIMVR(p=0.22). Stroke occurred in 1.1% of TERMVR and 0.4% of MIMVR (p=0.36). Freedom from reoperation within one year was 99.5% in TERMVR and 98.5% in MIMVR(p=0.94). Conclusions: Expect for CPB time, TERMVR showed better or equivalent outcomes compared to MIMVR. Especially, transfusion avoidance rate was spectacular in TERMVR. Totally Endoscopic Robot-Assisted Mitral Valve Repair provides safe and satisfying outcomes to patients while retaining the quality of valve repair.
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