Is the mitral valve repair rate with robotic surgery as high as in open surgery?

The simple answer is yes and may be higher.  My own repair rate is around 95-98%. Repair is strongly preferred over replacement (with a cow or pig valve or mechanical valve which have their drawbacks) in most patients. In general, the only valves I don’t repair are those in which the valve is so damaged that there is nothing left to reasonably repair and get a durable result.  No reasonable surgeon would repair such valves.  There has never been a “head to head” randomized trial comparing open surgery to robotic mitral repair, but most retrospective series of patients undergoing robotic mitral repair show a much higher rate of repair than national averages.  There are high volume surgeons doing repairs through open surgery who have similarly high rates of repair.  The overall surgeon experience with repair is more important than the type of surgery regarding repair rates.  One study showed the median number of mitral surgeries per surgeon in the US is 5/year with a repair rate of <41% (Tex Heart Inst J. 2011; 38(6): 703–704.). I would only go to a surgeon doing more than 50-100 repairs/year on average.

The repair techniques in robotics are the same as for open surgery.  More important than going to a surgeon for a minimally invasive approach is going to a surgeon and program that does a high volume of mitral valve repair with good results (a mitral valve specialist surgeon/center or “reference center”).  Having done many mitral repairs both in open surgery and endoscopic robotic surgery, I personally feel strongly that it is much easier to repair a valve robotically due to the excellent view of the valve by the 3D robotic HD camera that I place right over the valve.  Also, the heart sits in its natural position with a robotic surgery as opposed to open surgery where we have to retract (move) the heart into position to see the valve.  Of course, I continue to tell all my patients that for every way to perform mitral valve surgery, I know a surgeon that does it that way I would trust with my own family; I just prefer robotics because of the potential for early recovery and for me, an easier repair.  I see no advantage of sternotomy (open surgery with breastbone split) over endoscopic robotic mitral surgery with regard to repair techniques and repair rates.


← Is the mitral valve repair rate with robotic surgery as high as in open surgery?
T. Sloane Guy, MD

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