Author + information
- Avi Goodman,
- Tomislav Mihaljevic,
- A. Gillinov,
- Marijan Koprivanac,
- Marta Kelava,
- Rajeswaran Jeevanantham,
- Sarah Williams and
- Eugene Blackstone
Adoption of robotic approaches in cardiac surgery has been slow, due in part to perceived technical operative complexity and poorly understood learning curves. We sought to correlate changes in operative efficiency and success, safety, and clinical effectiveness with surgeon experience.
From 2006–2010, two surgeons undertook robotically–assisted isolated posterior leaflet mitral valve repair in 458 patients, of which 404 were completed entirely robotically. Learning curves were constructed by modeling surgical sequence number in a semi–parametric manner with spline–smoothed best–fit curves.
All markers of operative efficiency improved significantly with experience. From case 1 to cases 200 and 400, operating room time decreased 12% and 23%, cardiopulmonary bypass time decreased 32% and 37%, and aortic ischemic time decreased 36% and 42%. Also decreased were the likelihood of pre–discharge MV regurgitation > 0 (by 28% and 56%), blood product usage (67% and 88%), and post–operative ICU stay (13% and 25%) and hospital stay (13% and 27%). Conversions to a conventional approach, morbidity, new–onset atrial fibrillation, and return–to–work times did not change significantly. There were no deaths.
Although it is a complex undertaking, surgeons can improve their operative efficiency and clinical effectiveness for robotic mitral valve repair while performing the operations in a consistently safe and successful manner throughout the learning experience.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Evolving Concepts for the Optimal Management of Mitral Regurgitation from E–Clip to Robotics
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 1111–80
- 2013 American College of Cardiology Foundation