Robotic Approach to Mitral Valve Surgery in Septo-Octogenarians

Abstract

Advanced age confers higher Society of Thoracic Surgeons (STS) predicted risks of mortality and longer hospital lengths of stay (LOS) in patients undergoing mitral valve surgery; some consider it a contraindication to robotic-assisted approaches. We analyzed the feasibility and safety of totally endoscopic robotic mitral valve surgery (TERMS) in patients ≥70 years. From 5/11 to 4/18, 570 consecutive patients underwent TERMS by the same 2-surgeon team utilizing the da Vinci Xi Surgical System. Differences in patient demographics, intraoperative variables, and outcomes were analyzed between septo-octogenarian (patients ≥70 years) and younger patients (<70 years). Patients requiring left ventricle patch reconstruction following mitral annular calcification resection were excluded. For those patients with STS predicted risk scores (n = 439), our outcomes were compared to those STS predictions. Patients ≥70 comprised 25% of our TERMS cohort. Patients ≥70 had higher rates of preoperative atrial fibrillation and congestive heart failure, and significantly higher STS predicted risks of mortality. Patients ≥70 had greater incidence of concomitant cryoablation, hybrid percutaneous coronary intervention, and tricuspid repair. Patients ≥70 did not have longer cardiopulmonary bypass or aortic occlusion times. Thirty-day mortality was similar between groups (P = 0.151). Median LOS was 1 day longer for patients ≥70, 4 vs 3 days (P < 0.001). Short LOS (<6 days) was achieved in 72% of patients ≥70, markedly outperforming the STS predicted rates (36%). Advanced age is not a limiting factor for robotic mitral valve surgery in most patients. TERMS in patients ≥70 years matched STS benchmark performance outcomes and provided excellent recovery as evidenced by the short LOS (<6 days) experienced by the majority of septo-octogenarian patients.