title: Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized.
abstract: OBJECTIVE
  Robotic mitral valve repair is the least invasive approach to mitral valve repair, yet there are few data comparing its outcomes with those of conventional approaches. Therefore, we compared outcomes of robotic mitral valve repair with those of complete sternotomy, partial sternotomy, and right mini-anterolateral thoracotomy.
  
  
  METHODS
  From January 2006 to January 2009, 759 patients with degenerative mitral valve disease and posterior leaflet prolapse underwent primary isolated mitral valve surgery by complete sternotomy (n = 114), partial sternotomy (n = 270), right mini-anterolateral thoracotomy (n = 114), or a robotic approach (n = 261). Outcomes were compared on an intent-to-treat basis using propensity-score matching.
  
  
  RESULTS
  Mitral valve repair was achieved in all patients except 1 patient in the complete sternotomy group. In matched groups, median cardiopulmonary bypass time was 42 minutes longer for robotic than complete sternotomy, 39 minutes longer than partial sternotomy, and 11 minutes longer than right mini-anterolateral thoracotomy (P < .0001); median myocardial ischemic time was 26 minutes longer than complete sternotomy and partial sternotomy, and 16 minutes longer than right mini-anterolateral thoracotomy (P < .0001). Quality of mitral valve repair was similar among matched groups (P = .6, .2, and .1, respectively). There were no in-hospital deaths. Neurologic, pulmonary, and renal complications were similar among groups (P > .1). The robotic group had the lowest occurrences of atrial fibrillation and pleural effusion, contributing to the shortest hospital stay (median 4.2 days), 1.0, 1.6, and 0.9 days shorter than for complete sternotomy, partial sternotomy, and right mini-anterolateral thoracotomy (all P < .001), respectively.
  
  
  CONCLUSIONS
  Robotic repair of posterior mitral valve leaflet prolapse is as safe and effective as conventional approaches. Technical complexity and longer operative times for robotic repair are compensated for by lesser invasiveness and shorter hospital stay.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. mihaljt@ccf.org
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: Craig M
authors.initials: CM
authors.lastname: Jarrett
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Williams
authors.forename: Pierre A
authors.initials: PA
authors.lastname: DeVilliers
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000601:surgery*; D009820:Ohio; D010996:Pleural Effusion / Q000209:etiology; D057216:Propensity Score; D012371:Robotics; D056346:Sternotomy / Q000009:adverse effects; D025321:Surgery, Computer-Assisted; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome