In the first analysis comparing intermediate outcomes for mitral valve repair using endoscopic-assisted minithoracotomy or port-access (PORT) and robotic-assisted repair (ROBO), a team of Duke heart specialists reported similar outcomes in perioperative morbidity as well as survival and durability.

The retrospective, single-center analysis published in the Journal of Cardiac Surgery reviewed outcomes for 129 ROBO and 628 PORT mitral repairs involving Duke Health patients over a five-year period. Duke heart surgeon Donald D. Glower,  Jr., MD, senior author, says the findings indicate that risk of complications is low for healthy patients and should reduce concerns among surgeons who have been wary of using the new techniques. The five-year review is considered an intermediate analysis.

“The main message is one of reassurance, primarily because the robotic procedure is relatively new,” Glower says. “Some surgeons still express doubt that a robotic valve repair can be as effective as the standard breast bone entry. These data should reassure those who have concerns.”

The study is only the third analysis to compare PORT and ROBO techniques to each other and the first to review five-year outcome data. The study’s outcome analysis provides the most extensive data available on the procedures so far. The ROBO and PORT mitral platforms share similarities in the minithoracotomy incision, cannulation strategy, and instrumentation, the authors note.

The FDA approved PORT mitral valve repair in 1996; the robotic procedure was approved in 2002. Duke adopted both techniques quickly, becoming the fourth center to use PORT and deploying ROBO the year it was approved.

The ROBO method of mitral repair involved longer pump and clamp time than PORT, requiring more time in the OR, the study noted. But the longer OR stay did not affect outcomes. “Overall, the likelihood of experiencing complications is low for healthy people,” Glower says. “We did not see any differences in terms of time in the hospital or death. In fact, deaths were well under 1% in both groups.”

Despite the positive outcome data covering five years, Glower cautioned that the procedure is most effective when performed by experienced surgical teams who complete a high volume of minimally invasive mitral valve repair. Duke Health has been in the top five nationally in terms of minimally invasive mitral valve repair volume, performing approximately 150 procedures per year.

“Although both minimally invasive procedures are relatively new, they now have a 20-year track record,” Glower says. “We are learning they can be very durable techniques for the appropriate patients.”

In addition to Glower, other Duke contributors to the study included heart surgeons Jeffrey G. Gaca, MD, and Brittany Anne Zwischenberger, MD; Rahul S. Loungani, MD, a cardiology fellow; and Richard M. Sabulsky, PA.