Efficacy comparison between robot-assisted and conventional mitral valve surgery: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHEN Chong , ZHANG Yudong , HE Yi , TENG Fei

Basic Surgery Teaching Experimental Center, The First Clinical Medical College of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, P.R.China;

Corresponding author：

CHEN Chong, Email: 1098065381@qq.com

Keywords：

Robot-assisted surgery; conventional mitral valve surgery; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202007018

Video：

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Objective Through comparing the therapeutic efficacy of robot-assisted surgery (RS) and conventional surgery (CS) for mitral valve disease by meta-analysis to guide the choice of clinical operation.Methods Databases including The Cochrane Library, PubMed, EMbase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc) and Wanfang Database were searched by computer from inception to June 2020. The literature of efficacy comparison between RS and CS was collected. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and evaluated the quality of the literature. Meta-analysis was performed using RevMan 5.4 software.Results We identified 11 studies of RS versus CS with 4 330 patients. Among them, 2 212 patients underwent RS and 2 118 underwent CS. Meta-analysis demonstrated that compared with the CS, RS had longer cross-clamp time (MD=25.00, 95%CI 15.04 to 34.95, P<0.000 01), cardiopulmonary bypass time (MD=44.11, 95%CI 29.26 to 58.96, P<0.000 01) and operation time (MD=46.40, 95%CI 31.55 to 61.26, P<0.000 01). However, ICU stay (MD=–22.13, 95%CI –31.88 to –12.38, P<0.000 01) and hospital stay (MD=–1.81, 95%CI –2.69 to –0.92, P<0.000 01) were significantly shorter in the RS group; and the incidences of blood transfusion (OR=0.38, 95%CI 0.16 to 0.89, P=0.03) and complications (OR=0.73, 95%CI 0.57 to 0.94, P=0.01) were significantly lower in the RS group.Conclusion Although RS has a longer operation time than CS, it has less damage, less bleeding, faster recovery and better curative efficacy.

Citation： CHEN Chong, ZHANG Yudong, HE Yi, TENG Fei. Efficacy comparison between robot-assisted and conventional mitral valve surgery: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1326-1331. doi: 10.7507/1007-4848.202007018 Copy

1.	Speziale G, Nasso G, Esposito G, et al. Results of mitral valve repair for Barlow disease (bileaflet prolapse) via right minithoracotomy versus conventional median sternotomy: a randomized trial. J Thorac Cardiovasc Surg, 2011, 142(1): 77-83.
2.	Ryan WH, Brinkman WT, Dewey TM, et al. Mitral valve surgery: comparison of outcomes in matched sternotomy and port access groups. J Heart Valve Dis, 2010, 19(1): 51-58.
3.	Coyan G, Wei LM, Althouse A, et al. Robotic mitral valve operations by experienced surgeons are cost-neutral and durable at 1 year. J Thorac Cardiovasc Surg, 2018, 156(3): 1040-1047.
4.	Folliguet T, Vanhuyse F, Constantino X, et al. Mitral valve repair robotic versus sternotomy. Eur J Cardiothorac Surg, 2006, 29(3): 362-366.
5.	Hawkins RB, Mehaffey JH, Mullen MG, et al. A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery. Heart, 2018, 104(23): 1970-1975.
6.	Kam JK, Cooray SD, Kam JK, et al. A cost-analysis study of robotic versus conventional mitral valve repair. Heart Lung Circ, 2010, 19(7): 413-418.
7.	Kesävuori R, Raivio P, Jokinen JJ, et al. Early experience with robotic mitral valve repair with intra-aortic occlusion. J Thorac Cardiovasc Surg, 2018, 155(4): 1463-1471.
8.	Mihaljevic T, Jarrett CM, Gillinov AM, et al. Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized. J Thorac Cardiovasc Surg, 2011, 141(1): 72-80.
9.	Seo YJ, Sanaiha Y, Bailey KL, et al. Outcomes and resource utilization in robotic mitral valve repair: Beyond the learning curve. J Surg Res, 2019, 235: 258-263.
10.	Stevens LM, Rodriguez E, Lehr EJ, et al. Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations. Ann Thorac Surg, 2012, 93(5): 1462-1468.
11.	Suri RM, Burkhart HM, Daly RC, et al. Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: establishing the benchmark against which percutaneous interventions should be judged. J Thorac Cardiovasc Surg, 2011, 142(5): 970-979.
12.	Wang A, Brennan JM, Zhang S, et al. Robotic mitral valve repair in older individuals: An analysis of the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2018, 106(5): 1388-1393.
13.	Woo YJ, Nacke EA. Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay. Surgery, 2006, 140(2): 263-267.
14.	Falk V, Walther T, Autschbach R, et al. Robot-assisted minimally invasive solo mitral valve operation. J Thorac Cardiovasc Surg, 1998, 115(2): 470-471.
15.	Carpentier A, Loulmet D, Aupècle B, et al. Computer assisted open heart surgery. First case operated on with success. C R Acad Sci Ⅲ, 1998, 321(5): 437-442.
16.	Chitwood WR, Rodriguez E, Chu MW, et al. Robotic mitral valve repairs in 300 patients: a single-center experience. J Thorac Cardiovasc Surg, 2008, 136(2): 436-441.

1. Speziale G, Nasso G, Esposito G, et al. Results of mitral valve repair for Barlow disease (bileaflet prolapse) via right minithoracotomy versus conventional median sternotomy: a randomized trial. J Thorac Cardiovasc Surg, 2011, 142(1): 77-83.
2. Ryan WH, Brinkman WT, Dewey TM, et al. Mitral valve surgery: comparison of outcomes in matched sternotomy and port access groups. J Heart Valve Dis, 2010, 19(1): 51-58.
3. Coyan G, Wei LM, Althouse A, et al. Robotic mitral valve operations by experienced surgeons are cost-neutral and durable at 1 year. J Thorac Cardiovasc Surg, 2018, 156(3): 1040-1047.
4. Folliguet T, Vanhuyse F, Constantino X, et al. Mitral valve repair robotic versus sternotomy. Eur J Cardiothorac Surg, 2006, 29(3): 362-366.
5. Hawkins RB, Mehaffey JH, Mullen MG, et al. A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery. Heart, 2018, 104(23): 1970-1975.
6. Kam JK, Cooray SD, Kam JK, et al. A cost-analysis study of robotic versus conventional mitral valve repair. Heart Lung Circ, 2010, 19(7): 413-418.
7. Kesävuori R, Raivio P, Jokinen JJ, et al. Early experience with robotic mitral valve repair with intra-aortic occlusion. J Thorac Cardiovasc Surg, 2018, 155(4): 1463-1471.
8. Mihaljevic T, Jarrett CM, Gillinov AM, et al. Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized. J Thorac Cardiovasc Surg, 2011, 141(1): 72-80.
9. Seo YJ, Sanaiha Y, Bailey KL, et al. Outcomes and resource utilization in robotic mitral valve repair: Beyond the learning curve. J Surg Res, 2019, 235: 258-263.
10. Stevens LM, Rodriguez E, Lehr EJ, et al. Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations. Ann Thorac Surg, 2012, 93(5): 1462-1468.
11. Suri RM, Burkhart HM, Daly RC, et al. Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: establishing the benchmark against which percutaneous interventions should be judged. J Thorac Cardiovasc Surg, 2011, 142(5): 970-979.
12. Wang A, Brennan JM, Zhang S, et al. Robotic mitral valve repair in older individuals: An analysis of the Society of Thoracic Surgeons Database. Ann Thorac Surg, 2018, 106(5): 1388-1393.
13. Woo YJ, Nacke EA. Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay. Surgery, 2006, 140(2): 263-267.
14. Falk V, Walther T, Autschbach R, et al. Robot-assisted minimally invasive solo mitral valve operation. J Thorac Cardiovasc Surg, 1998, 115(2): 470-471.
15. Carpentier A, Loulmet D, Aupècle B, et al. Computer assisted open heart surgery. First case operated on with success. C R Acad Sci Ⅲ, 1998, 321(5): 437-442.
16. Chitwood WR, Rodriguez E, Chu MW, et al. Robotic mitral valve repairs in 300 patients: a single-center experience. J Thorac Cardiovasc Surg, 2008, 136(2): 436-441.

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Efficacy comparison between robot-assisted and conventional mitral valve surgery: A systematic review and meta-analysis

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