Outcomes comparison between robotic and conventional mitral valve surgery: a systematic review and meta-analysis

Abstract

Abstract Background Robotic-assisted cardiac surgery has emerged as a popular minimal invasive cardiac surgery approach, as it provides several advantages compared to conventional and other minimally invasive approaches. Mitral valve surgeries, including repair and replacement, are currently the most common cardiac surgeries performed with a robotic approach. However, there are concerns that surgeon's learning curve and prolonged operation time associated with this approach could compromise the surgical outcomes, hence the low acceptance of the technique in the clinical setting. In addition, despite various studies comparing robotic and conventional mitral surgery, it remains unclear whether the former would give comparable, if not better, outcomes. Purpose This study aims to compare the outcomes of robotic and conventional sternotomy mitral valve surgeries. Methods A comprehensive literature search was performed through Pubmed, CENTRAL, and ScienceDirect for studies comparing robotic and sternotomy approach for mitral valve repair and replacement. Studies were screened with our eligibility criteria, and their quality was examined using the Newcastle-Ottawa scale. The primary outcome analysed in this study was the perioperative mortality. Results Twelve studies involving 4300 patients (2223 experienced robotic surgery) were included. Pooled analysis showed that patients who underwent robotic surgery had a significant decrease in perioperative mortality compared to those who underwent sternotomy surgery (RR 0.33, 95% CI 0.18, 0.60, p=0.0003, I2=0%). Moreover, ICU length of stay was also shorter in the robotic group (MD −13.67, 95% CI −20.04, −7.29, p<0.0001, I2=93%). Re-operation risk due to bleeding was not significantly different between both groups (RR 1.13, 95% CI 0.79, 1.62, p=0.51, I2=0%). Egger's test result showed no evidence of small-study effects (p=0.83), and the funnel plot appeared symmetrical, meaning there was no publication bias. Conclusion Results from our meta-analysis refute the current concerns limiting the acceptance of robotic approach in mitral valve surgeries, showing significantly lower perioperative mortality and ICU length of stay, as well as a comparable re-operation risk due to bleeding with the conventional approach. Funding Acknowledgement Type of funding sources: None.