title: Cost-benefit analysis of robotic versus nonrobotic minimally invasive mitral valve surgery.
abstract: OBJECTIVE
  To date, a direct comparison of minimally invasive mitral valve repair or replacement (mini-MVR) versus robotic MVR is lacking; therefore, the purpose of this study was to address this deficit and compare mini-MVR with robotic MVR from a cost-benefit perspective.
  
  
  METHODS
  From a total of 759 literature citations, 21 studies were included for statistical comparisons of benefit outcomes, whereas 3 studies and our institutional experience were used to compare costs.
  
  
  RESULTS
  The total cost per case exceeding that of conventional MVR is approximately $2063.90 for robotic MVR and $271 for mini-MVR. Mean 30-day mortality rates for mini-MVR and robotic MVR groups were 1.24% and 0.55%, respectively [106/8548 vs 6/1089; odds ratio (OR), 2.27; P = 0.052]. The conversion rate to conventional MVR was 0.77% in mini-MVR and 1.83% in robotic MVR (35/5092 vs 22/1046; OR, 0.32; P < 0.001). The rate of neurologic events was 1.32% in mini-MVR and 2.37% in robotic MVR (109/8257 vs 20/845; OR, 0.55; P = 0.02). Postoperative atrial fibrillation was seen in 11.42% of mini-MVR patients and in 19.67% of robotic MVR patients (371/3249 vs 203/1032; OR, 0.53, P < 0.001). Mean cardiopulmonary bypass time was longer in mini-MVR (137.4 vs 130.4 minutes), whereas cross-clamp time was shorter (82.2 vs 96.7 minutes).
  
  
  CONCLUSIONS
  Our comparative analysis provides insights into the clinical benefits versus variable costs relationship related to mini-MVR and robotic MVR.
authors: From the *Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico, Albuquerque, NM USA; and †Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, OH USA.
authors: Mohammed
authors: M
authors: Hassan
authors: Yongjie
authors: Y
authors: Miao
authors: Joy
authors: J
authors: Lincoln
authors: Marco
authors: M
authors: Ricci
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*