A Systematic Literature Review and Meta-Analysis Comparing Robotic-Assisted Mitral Valve Repair Using the Da Vinci Surgical System to Open Mitral Valve Repair
Author(s)
Ana Yankovsky, MSc1, Neera Patel, MS1, Usha Kreaden, MSc2.
1Intuitive Surgical, Sunnyvale, CA, USA, 2Managing Fellow, Biostatistics, Access & Evidence, Intuitive Surgical, Sunnyvale, CA, USA.
1Intuitive Surgical, Sunnyvale, CA, USA, 2Managing Fellow, Biostatistics, Access & Evidence, Intuitive Surgical, Sunnyvale, CA, USA.
OBJECTIVES: This systematic literature review and meta-analysis compares the perioperative clinical outcomes of robotic-assisted (rMVR), open (oMVR) and mini-thoracotomy (mini-MVR) mitral valve repair.
METHODS: A PRISMA-guided literature review was conducted using Pubmed, Scopus, and Embase covering 01/01/2010 to 01/11/2024 (Prospero #CRD420250652462). Inclusion criteria consisted of publications involving adults with mitral valve disease requiring repair of the mitral valve, in the form of RCTs, large database, prospective, and retrospective cohort studies with a sample size greater than 20 in each arm and quantifiable perioperative safety and effectiveness outcomes. Data were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effects or random-effects (heterogeneity significant).
RESULTS: The search identified 25 eligible studies (17 retrospective, 5 database, 2 prospective, and 1 RCT), including 12,133 rMVR, 8,496 mini-MVR, and 9,685 oMVR patients. Mini-MVR and rMVR were comparable with respect to outcomes of safety and effectiveness. Compared to oMVR, rMVR operative time was 43.5 minutes longer (p<0.01). Additionally, patients undergoing rMVR were 48% less likely to receive a blood transfusion postoperatively (OR:0.52, [0.31, 0.88] p=0.01), had shorter ICU stay by 0.4 days (p=0.03), had shorter hospital stay by 1.3 days ( p<0.01), were 28% less likely to experience postoperative atrial fibrillation (OR: 0.72, [0.62, 0.84] p<0.01) and 47% less likely to experience short-term mortality (OR: 0.53, [0.31, 0.92] p=0.03) compared to oMVR patients.
CONCLUSIONS: Current evidence demonstrates that rMVR is comparable to mini-MVR repair and offers numerous benefits over oMVR. While further prospective comparative studies are warranted, rMVR is a safe and effective choice over oMVR. This information may be helpful for payers, policymakers, and Health Technology Agencies.
METHODS: A PRISMA-guided literature review was conducted using Pubmed, Scopus, and Embase covering 01/01/2010 to 01/11/2024 (Prospero #CRD420250652462). Inclusion criteria consisted of publications involving adults with mitral valve disease requiring repair of the mitral valve, in the form of RCTs, large database, prospective, and retrospective cohort studies with a sample size greater than 20 in each arm and quantifiable perioperative safety and effectiveness outcomes. Data were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effects or random-effects (heterogeneity significant).
RESULTS: The search identified 25 eligible studies (17 retrospective, 5 database, 2 prospective, and 1 RCT), including 12,133 rMVR, 8,496 mini-MVR, and 9,685 oMVR patients. Mini-MVR and rMVR were comparable with respect to outcomes of safety and effectiveness. Compared to oMVR, rMVR operative time was 43.5 minutes longer (p<0.01). Additionally, patients undergoing rMVR were 48% less likely to receive a blood transfusion postoperatively (OR:0.52, [0.31, 0.88] p=0.01), had shorter ICU stay by 0.4 days (p=0.03), had shorter hospital stay by 1.3 days ( p<0.01), were 28% less likely to experience postoperative atrial fibrillation (OR: 0.72, [0.62, 0.84] p<0.01) and 47% less likely to experience short-term mortality (OR: 0.53, [0.31, 0.92] p=0.03) compared to oMVR patients.
CONCLUSIONS: Current evidence demonstrates that rMVR is comparable to mini-MVR repair and offers numerous benefits over oMVR. While further prospective comparative studies are warranted, rMVR is a safe and effective choice over oMVR. This information may be helpful for payers, policymakers, and Health Technology Agencies.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO2
Topic
Clinical Outcomes, Medical Technologies, Methodological & Statistical Research
Topic Subcategory
Clinical Outcomes Assessment
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)