Outcomes of Robotic Mitral Valve Repair in Patients Older Than 65 Years

T. Sawma¹, P. Rowse¹, R. Daly¹, A. Todd¹, y. Nabeel. Aljamal¹, J. Dearani¹, J. Crestanello¹, H. Schaff², A. Arghami^1
1Mayo Clinic, Rochester, Minnesota ²Mayo Clinic, Mayo Clinic, Minnesota

Purpose: Although mitral regurgitation is common with increasing prevalence in older patients, the invasive nature of surgery can deter patient and providers from seeking treatment. Our study aims to asses early and late outcomes of robotic mitral repair in patients over 65 and to compare them with those of median sternotomy.

Methods: Between 2010 and 2024, we identified patients over 65 years old who underwent their first isolated mitral valve repair, either through a robotic approach or a standard median sternotomy. Data was collected from our institutional prospectively maintained cardiovascular surgery database and quality-of-life surveys administered at 1, 3, and 5 years post-operation. All patients had comprehensive transthoracic echocardiography before their mitral valve repair. The primary endpoints were long-term all-cause mortality and the need for future reintervention. Inverse probability weighting was applied to balance the groups when comparing all outcomes. This adjustment controlled for baseline variables including age, gender, diabetes, BMI, creatinine, dyslipidemia, hypertension, immunosuppression, previous myocardial infarction, atrial fibrillation, previous percutaneous coronary intervention, beta blocker use, calcium channel blocker use, ejection fraction, NYHA class III/IV, and peripheral arterial disease.

Results: A total of 613 patients were included in the study (299 robotic and 314 sternotomy patients). Median age was 69 years in the Robotic group and 72 years in the Sternotomy group. Thirty-three percent of the patients were females. Patients in the robotic group had lower frequency of diabetes, hypertension, atrial fibrillation, and atherosclerotic diseases. All reported outcomes were adjusted for baseline indifferences using propensity-weights. Patients in the robotic group had smaller rates of blood transfusion (OR = 0.5, p< 0.001), postoperative atrial fibrillation (OR=0.74, p=0.011) and total ICU stay (p=0.008). Operative mortality was 0.3% in both groups, and total hospital stay was 4 days (3-4) in the robotic group and 5 days (4-6) in the sternotomy group (p < 0.001) (Table 1). Direct discharge to home was much higher in the robotic arm as compared to the sternotomy arm (98% vs 85%, p< 0.001). There was no significant difference in long-term survival and reintervention-free survival between the 2 groups after weight adjustment (p=0.13, p=0.71). When surveyed at 1 year, 3 years, and 5 years, both groups reported excellent physical activity (“similar or superior to their peers”) and the difference was not significant between the two groups (Figure 1).

Conclusion: Robotic MV repair in older patients is associated with better short-term postoperative outcomes (hospital and ICU stay, atrial fibrillation, blood transfusion) compared to standard median sternotomy. Both robotic and open approaches show similar long-term survival rates, reintervention-free survivals, and excellent self-reported physical activity level.

Identify the source of the funding for this research project: No funding was needed for the study