title: Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: establishing the benchmark against which percutaneous interventions should be judged.
abstract: OBJECTIVE
  Recent reports have shown that robotic mitral valve repair is effective in treating posterior leaflet disease; however, comparison with trans-sternal (open) valvuloplasty for all prolapse categories has not been performed. Moreover, data from the recently published EVEREST II trial infer that adverse event rates after mitral valve repair for degenerative disease are high. We therefore compared early outcomes of robotic versus open mitral valve repair for patients with mitral valve prolapse.
  
  
  METHODS
  Among 745 consecutive patients undergoing open or robotic mitral repair for degenerative disease, 95 propensity-matched pairs were identified. Leaflet prolapse categories were similar between groups. Complete mitral valve repair was performed using identical techniques.
  
  
  RESULTS
  Median crossclamp and bypass times were longer in the robotic group but decreased significantly over time (P < .001). There were no conversions to open sternotomy, repair rate and early survival were 100%, dismissal mitral regurgitation grade was similar (P = 1.00), and all patients in the robotic group had mild or less mitral regurgitation at 1 month after repair. There were no differences in adverse events (5% open vs 4% robotic, P = 1.00). Patients in the robotic group had shorter postoperative ventilation time, intensive care unit stay, and hospital stay.
  
  
  CONCLUSIONS
  Robotic mitral valve repair allows complete anatomic correction of all categories of leaflet prolapse using techniques identical to open approaches. Robotic repair effectively corrects mitral regurgitation, offers excellent freedom from adverse events, and facilitates rapid weaning from ventilation, translating into earlier hospital dismissal. Safety and efficacy after both open and robotic mitral valve repair are higher than recently reported in the EVEREST II trial and establish a benchmark against which nonsurgical therapies should be evaluated.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA. suri.rakesh@mayo.edu
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000328:Adult; D000368:Aged; D019985:Benchmarking; D006328:Cardiac Catheterization / Q000592:standards*; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000592:standards*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000628:therapy; D008945:Mitral Valve Prolapse / Q000601:surgery*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012371:Robotics / Q000592:standards*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome