Robotic Mitral Valve Repair for Simple and Complex Degenerative Disease: Midterm Clinical and Echocardiographic Quality Outcomes.
BACKGROUND
Severe primary (degenerative) mitral regurgitation (MR) is repaired with durable results when simple single-scallop disease is addressed. The midterm quality outcomes of minimally invasive repair for complex disease are unknown, however.


RESULTS
From January 2008 to January 2015, 487 patients (56±11 years, 360 men, ejection fraction 65±6%, 98.8% complete follow-up) underwent robotic mitral valve repair for severe nonischemic degenerative MR. Simple pathology was addressed in 289 of 487 (59%) patients, and complex repair (all others) was performed in 198 of 487 (41%). Four patients died during follow-up with a 5-year survival rate 99.5% (99.4% simple; 99.5% complex; hazard ratio, 0.48; 95% confidence interval, 0.05-4.59); and New York Heart Association functional class I/II was documented in 97.9% (477/487). Eight patients had recurrence of moderate-to-severe MR (4 simple, 4 complex), with a 5-year freedom from MR of 94.6% (96.2% simple; 92.7%, complex; P=0.67; hazard ratio, 1.36; 95% confidence interval, 0.34-5.43). Seven patients (2 simple, 5 complex), underwent mitral reoperation, with a 5-year freedom from reoperation of 97.7% (99.1% simple; 95.7% complex; P=0.13; hazard ratio, 3.35; 95% confidence interval, 0.65-17.32).


CONCLUSIONS
At a large tertiary care referral center, midterm quality outcomes after robotic correction of degenerative MR are excellent, with very high survival, infrequent complications, and a low likelihood of MR recurrence, regardless of mitral valve repair complexity. Awareness of these improvements in outcome is important to inform contemporary decisions regarding high-quality alternatives to conventional and percutaneous mitral repair.
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN. surir@ccf.org.
Rakesh M
RM
Suri
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
Amit
A
Taggarse
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
Harold M
HM
Burkhart
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
Richard C
RC
Daly
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
William
W
Mauermann
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
Rick A
RA
Nishimura
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
Zhuo
Z
Li
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
Joseph A
JA
Dearani
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
Hector I
HI
Michelena
From Divisions of Cardiovascular Surgery (R.M.S., A.T., H.M.B., R.C.D., J.A.D.), Anesthesiology (W.M.), Cardiovascular Diseases (R.A.N., H.I.M., M.E.-S.), and Biomedical Statistics and Informatics (Z.L.), Mayo Clinic, Rochester, MN.
Maurice
M
Enriquez-Sarano
D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012306:Risk; D012371:Robotics; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014463:Ultrasonography
mitral valve; mitral valve annuloplasty; prolapse; quality improvement