Clinical Outcomes and Costs of Robotic-assisted versus Conventional Mitral Valve Repair: A National Analysis.

Background: Robotic approaches have been increasingly utilized for cardiothoracic operations, though concerns regarding costs remain. We evaluated short-term outcomes and costs of robotic-assisted and conventional mitral valve repair (MV-repair), hypothesizing that cost differences would be mitigated at high-volume programs.

Methods: Adults undergoing elective MV-repair from 2016 to 2020 were identified in the Nationwide Readmissions Database. Patients with rheumatic heart disease, mitral stenosis, and those undergoing concomitant operations were excluded. Generalized linear models were utilized to evaluate the association between approach and in-hospital mortality, complications, length of stay, costs, and 90-day readmissions. Annual institutional MV-repair volume was modeled using restricted cubic splines, and cost differences subsequently evaluated by volume tertile.

Results: Of 40,738 patients, 9.8% underwent robotic-assisted MV-repair. Risk-adjusted outcomes including mortality, stroke, reoperation, respiratory complications, postoperative infection, and readmission were comparable between the two groups, while those undergoing robotic-assisted MV-repair had lower rates of non-home discharge. The median cost of robotic-assisted MV-repair was greater than conventional surgery ($46,800 vs $38,500, p<0.001). Despite a 1.3-day decrement (95% CI 1.1-1.6) in length of stay, robotic-assisted MV-repair was associated with greater risk-adjusted costs by $10,500 (95% CI 5,800-15,200). Programs in the highest volume tertile exhibited comparable costs for robotic-assisted and conventional MV-repair (cost difference $5,900, 95% CI -1,200-12,200, p>0.05).

Conclusions: Robotic-assisted MV-repair had comparable short-term outcomes relative to conventional surgery. Despite increased costs of robotic-assisted MV-repair overall, high-volume programs had similar risk-adjusted costs by approach. These findings support the designation and performance of robotic MV-repair at centers of excellence in the United States.