Initial Experience With Robotic Mitral Valve Replacement: Results From a Single Centre

TL;DR

This study examines the learning curve and outcomes of robotic mitral valve replacement over a decade at a single center.

Contribution

The study identifies a measurable learning curve and the number of procedures needed to achieve surgical stability in robotic mitral valve replacement.

Findings

Cumulative sum analysis identified three phases in the learning curve: learning, proficiency, and mastery.

Approximately 93 procedures are needed to achieve operative stability and handle more complex cases.

Surgical efficiency and case complexity evolved over time with robotic mitral valve replacement.

Abstract

Robot-assisted mitral valve replacement has been shown to be comparable to conventional surgery in terms of safety and efficacy. Our institution has performed robot-assisted mitral valve replacement using the Da Vinci Surgical System for over a decade. This study aimed to evaluate the time-related evolution of clinical outcomes and the impact of the surgical learning curve.

Patients who underwent robot-assisted mitral valve replacement between July 2013 and January 2024 were evaluated. All procedures were performed by 4 surgeons certified in robotic cardiac surgery, each with prior experience of more than 100 conventional mitral valve replacements. To assess the learning curve, cumulative sum analysis was conducted on cardiopulmonary bypass time and the Mitral Surgery Complexity Score.

A total of 233 patients were included in the analysis. The mean patient age was 48.4 (13.9) years; 117 (50.2%) were male. The mean cardiopulmonary bypass time was 170.3 (55.1) min. Cumulative sum analysis of cardiopulmonary bypass time revealed 3 phases: a learning phase (cases 1-27), a proficiency phase (cases 28-92), and a mastery phase (cases 93 onward). Mitral Surgery Complexity Scores decreased during the early phase, followed by an increase after case 92, indicating a transition towards more complex cases.

Robot-assisted mitral valve replacement has a measurable learning curve, with surgical efficiency and case complexity evolving over time. Approximately 93 procedures appear necessary to achieve operative stability and to confidently expand indications to include more complex patients.

Prosthetic valve replacement may improve survival in patients with mitral valve pathology for whom mitral valve repair is not feasible or appropriate.

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