Robotic-Assisted Versus Conventional Mitral Valve Repair: an Updated Meta-Analysis of Operative and Post-Operative Outcomes

Introduction: Cardiac surgery has seen notable advancements, especially in mitral valve repair, with the emergence of robotic-assisted mitral valve repair (RAMVR). Amid ongoing debates about RAMVR's efficacy and safety versus conventional mitral valve repair (CMVR), this updated meta-analysis offers a comprehensive comparison based on recently published data. Aim: The study aims to provide a comparison of RAMVR and CMVR, focusing on key operative and postoperative outcomes. Methods: A systematic search was conducted utilizing databases such as PubMed, EMBASE, and the Cochrane Library, until January 2023. The inclusion criteria included studies that compared RAMVR with CMVR. The meta-analysis incorporated a random-effects model to calculate pooled mean differences (MD) and relative risks (RR). All statistical analyses were carried out using R software (version 4.0.3), by metafor and meta packages. Results: Ten studies with a total of 54,235 patients (5,092 in the RAMVR group and 49,143 in the CMVR group) were included. The meta-analysis showed that RAMVR was associated with a significantly shorter hospital stay (MD -1.79 days; 95% CI -2.77 to -0.83, P=<0.01, I2=100%) and ICU length of stay (MD -16.76 days; 95% CI -29.34 to -4.19, P=<0.01, I2=98%). However, RAMVR was associated with significantly longer cardiopulmonary bypass time (MD 42.90 minutes; 95% CI 29.58 to 56.22, P<0.01, I2=98%) and cross-clamp time (MD 29.67 minutes; 95% CI 19.84 to 39.51, P<0.01, I2=98%). In terms of relative risks, RAMVR had a lower rate of overall mortality (RR 0.55; 95% CI 0.42 to 0.74, P<0.01, I2=0%) and rate of infection (RR 0.62; 95% CI 0.52 to 0.74, P<0.01, I2=0%). However, there was no statistically significant difference in the rate of blood transfusion, stroke rate, atrial fibrillation, and transient ischemic attack. Conclusions: This study suggests that RAMVR may offer benefits such as shorter hospital and ICU stays and lower overall mortality and infection rates, but it also involves longer cardiopulmonary bypass and cross-clamp times. Given the high heterogeneity across the included studies, this underlines the importance of further high-quality randomized controlled trials to optimize RAMVR techniques for improving patient outcomes in mitral valve repair.