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Incidence And Impact Of Atrial Fibrillation: Comparing Outcomes Of Robotic Vs. Open Mitral Valve Repair
Youssef Shahin, Arman Arghami, Behrooz Banivaheb, Tedy Sawma, Phillip Rowse, Richard Daly, John Stulak, Juan Crestanello, Paul Tang, Hartzell Schaff, Joseph Dearani.
Mayo Clinic, Rochester, MN, USA.
BACKGROUND: In this retrospective, single-center study we evaluate the incidence of post-operative atrial fibrillation (POAF) following robotic mitral valve surgery, compare it to the standard sternotomy approach, and study the impact of AF on the short-term outcomes of surgery and 10-year survival of patients in each group
METHODS: 2627 patients with no history of AF underwent primary mitral valve repair (MVr) between 2010-2024, as primary, isolated procedures or concomitant with tricuspid valve repair. Patients with mitral valve stenosis and functional mitral valve insufficiency were excluded, the remainder of patients underwent a propensity score matched analysis with a 1:1 ratio, this yielded 664 patients in each of the robotic and open approach groups and the outcomes were analyzed.
RESULTS: There was a higher incidence of POAF after open MVr, with a hazard ratio of 2.14 (p < 0.001) (Fig.A), without an increased risk of stroke in the index hospitalization, the median time of onset of AF was the second post-operative day in both groups. Duration of operation, cardiopulmonary bypass, and cross clamp were longer in the robotic cohort (p<0.001) (Fig.B). Nevertheless, this was not associated with an increased risk of in-hospital cardiac or renal failure. POAF was not associated with a higher risk of recurrence of moderate/severe Mitral regurgitation with 14.5% at a median follow-up time of 43 months and11.7% at 39 months (p-value = 0.228) for POAF and non-POAF groups, respectively. The 10-year survival was not affected by the incidence of POAF in either open or robotic MVr groups (Fig.C,D).
CONCLUSIONS: In our study, Robotic MVr was associated with a lower incidence of AF in the immediate post-operative period. However, this was not associated with a difference in the incidence of other post-operative complications during index hospitalization. POAF did not affect the 10-year survival of patients in either group.
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