Quality Improvement

In today’s 11:30 a.m. session, "Robotic Cardiac Surgery: The Future Is Now," Dr. Tedy Sawma will discuss how mitral regurgitation, increasingly common in aging populations, presents unique challenges for older patients considering surgical treatment options. While mitral valve repair remains an effective solution, the invasiveness of traditional open-heart surgery often discourages both patients and healthcare providers.

In the Outcomes of Robotic Mitral Valve Repair in Patients Older Than 65 Years presentation, study investigators will highlight findings on robotic mitral valve repair in older patients, comparing outcomes with those from traditional median sternotomy. The study evaluates both short-term and long-term outcomes to determine whether robotic surgery offers advantages in recovery, quality of life, long-term survival, and the need for future interventions.

Researchers analyzed data from a cardiovascular surgery database, tracking patients who underwent their first isolated mitral valve repair between 2010 and 2024. They compared the outcomes of robotic procedures with those of traditional median sternotomy surgeries, adjusting for factors like age, gender, and comorbidities.

Primary outcomes included long-term all-cause mortality and the need for reinterventions, while secondary outcomes focused on hospital recovery metrics such as blood transfusions, atrial fibrillation rates, and ICU stay durations.

The findings to be discussed include how robotic mitral valve repair offered short-term advantages over traditional surgery, such as reduced ICU and hospital stays, fewer blood transfusions, and lower rates of postoperative atrial fibrillation. However, no significant differences were observed in long-term survival or the need for future interventions. Both groups maintained excellent physical activity levels and quality of life over the years. These results suggest that robotic mitral valve repair is a viable option for older patients, providing enhanced short-term recovery without compromising long-term outcomes.

A new study sheds light on the challenges of pediatric mitral valve replacement (MVR) and evaluates the potential of the balloon-expandable Melody valve as an alternative to traditional mechanical prostheses. The findings offer important insights for treating young children with small mitral annuli, a population for whom MVR carries significant risks of morbidity and mortality.

A team of researchers, led by Morgan Moroi, MD, New York-Presbyterian/Columbia University Medical Center, conducted a retrospective review of 36 children under 2 years of age who underwent MVR at a single center between 2005 and 2023. Using propensity score matching to minimize baseline differences, the study compared outcomes between 12 patients receiving the Melody valve and 12 patients treated with mechanical prostheses.

The primary outcome was a composite measure of death, transplant, or surgical reintervention on the mitral valve prosthesis. Median follow-up was 1.6 years.

Key Findings

Both groups had similar baseline characteristics, with a median age of 5.2 months and median weight of 6.5 kg at the time of surgery. The study revealed several important differences and similarities in outcomes:

• Hospital Stay: Melody valve patients had shorter hospital stays (median: 20.5 days) compared to mechanical valve patients (median: 59.0 days), though the difference was not statistically significant (P=0.11).
• Mitral Valve Gradients: The Melody valve group had significantly lower mitral valve gradients at discharge (5.5 mmHg vs. 8.7 mmHg, P=0.046).
• Permanent Pacemakers: No patients in the Melody group required a permanent pacemaker, while 41.7% of the mechanical group did (P=0.04).
• Reintervention Rates: Both groups experienced early surgical reinterventions at similar rates (33.3% vs. 25%, P=1.00).
• Survival Outcomes: At 1 and 3 years, transplant-free survival was comparable between the groups, with no significant difference (P=0.92).
   

Implications 

The findings suggest that the Melody valve offers several advantages over mechanical prostheses in young children with small mitral annuli, including lower rates of permanent pacemaker insertion and no need for lifelong anticoagulation. While early reintervention rates were high across both groups, the Melody valve demonstrated equivalent survival outcomes and may provide a safer and more effective option for this vulnerable patient population. However, the study authors emphasize the need for further research with larger cohorts and longer follow-up to confirm these promising results.