Y. Seo1, Y. Sanaiha1, K. Bailey1, E. Aguayo1, A. Mantha3, V. Dobaria2, A. Chao1, T. Fan1, N. Satou1, P. Benharash1 3University Of California – Irvine,Orange, CA, USA 1David Geffen School Of Medicine, University Of California At Los Angeles,Los Angeles, CA, USA 2University Of California – Los Angeles,Los Angeles, CA, USA
Introduction:
The additional cost burden associated robotic operations have been cited as a major barrier to the wide dissemination of this technology. Robotic valve operations have demonstrated similar safety and efficacy but higher initial costs when compared to open surgery. Previous studies have demonstrated the initial learning curve of robotic procedures to be followed by a plateau phase where operative time and complication rates stabilize. The objective of the present study was to evaluate our institutional experience with robotic mitral valve repairs (rMVR) beyond the learning curve, and to compare clinical and financial outcomes to the open approach.
Methods:
The prospectively-maintained institutional Society of Thoracic Surgeons database was utilized to identify all adult patients undergoing robotic and open isolated mitral valve repair from January 2008 to December 2016. Subjects with concomitant surgeries and previous cardiac surgeries were excluded. Multivariate regressions were performed to produce risk-adjusted operative times, complications, length of hospitalization, and costs. Financial data was obtained from the hospital database and adjusted for inflation. Categorical variables were analyzed by Fisher’s exact test and continuous variables were analyzed by the independent sample T-test for unequal sample size. An alpha of < 0.05 was considered statistically significant.
Results:
During the study period, 175 robotic and 259 open MVR cases were performed. Compared to open, rMVR patients were less likely to be hypertensive (51 vs 41%, p=0.002), or have chronic lung disease (13 vs 5%, p=0.005) and had higher hematocrit values (36 vs 39%, p<0.001) and ejection fractions (58 vs 60%, p=0.023). With increasing robotic experience, operative times decreased significantly as shown in Figure 1, but rates of complications, hospital and ICU lengths of stay did not change. Compared to costs of open surgery, rMVR was associated with 43% less cost (p=0.001), fewer cases needing postoperative blood products (27 vs 15%, OR=0.61, p=0.004) and lower rates of complication (46 vs 30%, OR=0.44, p=0.001). Also rMVR was associated with significantly shorter times in the ICU (84 vs 144 hours, p<0.001) and length of stay (6.5 vs 9.9 days, p<0.001).
Conclusion:
In this longitudinal single institution experience, increasing number of rMVR’s beyond the initial learning curve was associated with decreasing operative times. Our findings demonstrate comparable short-term outcomes between robotic and open MVR. Interestingly, the robotic approach was more cost effective likely due to shorter hospital and ICU length of stay. With increasing experience, robotic MVR can surpass the open technique in cost effectiveness while providing equivalent short term outcomes.
