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Degenerative Mitral Valve Disease: Thoracoscopic Versus Robotic Approach
Elena Sandoval, Anna Muro, Eduard Quintana, Jorge Alcocer, Clemente Barriuso, Jose Luis Pomar, Manuel Castella, Daniel Pereda.
Hospital Clinic, Barcelona, Spain.

OBJECTIVE:Our center has 20 years of experience in thoracoscopic mitral valve surgery, and we have recently started a robotic program (December 2019). We sought to compare both approaches for the treatment of degenerative mitral valve disease (DMVD).METHODS: Retrospective review of all patients with isolated DMVD who underwent minimally-invasive surgery between 2011 and 2021. Patients were classified in two groups according to the surgical approach; thoracoscopic and robotic (DaVinci Xi; Intuitive Surgical, USA).
RESULTS: 191 patients underwent thoracoscopic surgery and 50 patients underwent robotic surgery. There were no differences between the two groups regarding gender, age and other preoperative variables. Posterior leaflet prolapse was the most common dysfunction in both groups, but patients with anterior or bileaflet prolapse accounted for >30% on both groups. There was a higher use of neochordae in the robotic group (46% vs. 66%; p=0,02), due partially to our trend in this direction in recent years and a better dexterity with the robot. There were no differences between groups regarding duration of cardiopulmonary bypass, aortic cross-clamp, and mechanical ventilation. There were significant differences in favor of the robotic approach in both ICU stay (1d vs. 1d;p<0,01) and hospital stay (7d vs. 5d; p<0,001). Postoperative complications were low and similar between the two groups, and a successful mitral repair was accomplished in most patients in both groups (97% vs. 91%; p=0,34).
CONCLUSIONS: Despite being at the beginning of our robotic experience and the presence of a significant learning curve, our surgical results in DMVD already seem not to differ in quality from those obtained with our consolidated thoracoscopic approach, but providing a faster recovery of patients with significantly shorter ICU and hospital stays. We believe our prior experience in thoracoscopic surgery may have softened the robotic learning curve



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