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What Does The Automated Performance Metric “Console Time” Tell In Robotically Assisted Mitral Valve Repair?
Kei Kobayashi, Guo Yizhan, Thomas E. Rubino Jr., Martin Winter, Ariana Jackson, Luis Ramirez, Stephen D. Waterford, David West, David Kaczorowski, Ibrahim Sultan, Johannes Bonatti.
UPMC, Pittsburgh, PA, USA.
BACKGROUND: The time spent at the console is one of the automated performance metrics (APM) recorded by robot software during robotic cardiac surgery. Little is known about what this APM predicts. This study aimed to evaluate factors associated with console time during robotically assisted mitral valve repair (raMVR).
METHODS: A total of 112 patients underwent raMVR from 7/2021 to 5/2024. The mean age was 59.3 ± 12.9 years, 76 (67.9%) were male, and average STS risk of mortality was 0.6 ± 0.5 %. Surgical approaches included annuloplasty only (10, 8.9%), leaflet resection (73, 65.2%), placement of neochords (21, 18.8%), and a combination of resection and chordal replacement (8, 7.1%). Repairs were classified as non-complex (86, 76.7%) or complex (26, 23.3%). Associations between APMs and pre-, intra-, and postoperative variables were assessed.
RESULTS: Average console time was 115.7 ± 36.1 minutes, and instruments active time was 97.8 ± 23.4 minutes. On average, 4.2 ± 0.4 instruments were used, with 5.4 ± 2.8 instrument changes. Console time correlated significantly with body weight (R=0.236, p=0.012), body mass index (R=0.246, p=0.009), and body surface area (R=0.231, p=0.014). For non-complex raMVR, console time was 106.2 ± 27.1 min, compared to 125.8 ± 39.0 min for complex raMVR (p<0.001). The APM strongly correlated with CPB time (R=0.551, p<0.001), myocardial ischemic time (R=0.634, p<0.001), and total procedure time (R=0.540, p<0.001). Patients extubated in the operating room had shorter console times (109.8 ± 33.3 min vs. 125.8 ± 39.0 min, p=0.024). Longer console times correlated with increased incision length (R=0.214, p=0.023). There was no hospital mortality or permanent stroke. One patient (0.9%) required a late revision for bleeding. Console time was not prolonged in patients with postoperative atrial fibrillation (24, 21.4%) or those who received blood transfusions (15, 13.4%). Hospital stay did not correlate with the APM.
CONCLUSIONS:Console time is longer in obese patients and complex raMVR cases. This metric strongly correlates with operative times and is shorter in patients extubated in the operating room. Major postoperative outcomes and hospital stay are not associated with longer console time.
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