RESULTS
A total of 130 patients who underwent robotic and conventional mitral
valve replacement between 2014 and 2020 were included in our study. The
demographic data of the patients in Group I (Robotic mitral valve
replacement) and Group II (Conventional mitral valve replacement) are
given in Table 1. The patients included in our study were selected among
patients who underwent mitral valve replacement only, and patients who
underwent mitral valve repair, mitral ring annuloplasty, tricuspid valve
replacement, tricuspid valve repair, reoperation, and additional
coronary surgery were not included in our study.
In the conventional mitral valve replacement group, 36 (54%) female, 30
(46%) male 66 patients, and the robotic group 38 (59%) female, 26
(41%) male 64 patients in total 130 the patient was included in the
study. No statistically significant difference was found between the two
groups in terms of age, smoking history, COPD, HT, DM, HL, CRF, CVA and
peripheral artery disease (p> 0.05).
Average X-clamp times are 143 ± 27.4 minutes in Group I; It was found as
69 ± 15.2 minutes in Group II and this time was found to be
significantly higher in the r-MVR group (p <0.001)(Table
1)(Figure 1). In the same direction, CPB duration is 204 ± 45.8 minutes
in Group I; It was found to be 98 ± 17.8 minutes in Group II. In the
comparison between the two groups, this period was found to be
significantly higher in the r-MVR group (p <0.001)(Table
1)(Figure 1). The reason for the significant difference between the two
groups is that providing appropriate exposure and access technique in
robotic surgery, which is a minimally invasive method, is more difficult
than open surgery and requires more experience. While the average amount
of drainage was 290 ± 129 in Group I, it was 561 ± 136 in Group II. When
the mean drainage amounts of both groups were compared, it was found
that the drainage amount was significantly lower in the r-MVR group
compared to the c-MVR group (p <0.001)(Table 2). While the
need for erythrocyte suspension transfusion, which is thought to be
directly proportional to the amount of drainage, is 0.4 ± 0.3 in Group
I; It was found as 0.9 ± 1.2 in Group II, and a significant difference
was found between them in the comparison (p = 0.014).
The average length of stay in the intensive care unit of patients who
underwent robotic mitral valve replacement was 1.6 ± 0.8 days; In the
patient group who underwent conventional mitral valve replacement, this
period was 2.6 ± 1.0 days. Comparing the average length of stay in the
intensive care unit in both patient groups, these durations were found
to be significantly lower in Group I than in Group II (p=0.006). Kaplan
Meier analysis was performed and the difference between them was
confirmed by Log-Rank test (Log-Rank = 9.33; p <0.001)(Figure
2). The mean hospital stay of patients who underwent robotic mitral
valve replacement was 7.9 ± 2.9 days; It was found to be 9.4 ± 3.1 days
in the patient group who underwent conventional mitral valve
replacement. Comparing the average length of hospital stay in both
patient groups, this period was found to be significantly lower in Group
I than Group II (p = 0.003). Again, Kaplan Meier analysis was performed
and the difference between them was confirmed by Log-Rank test (Log-Rank
= 8.66; p = 0.003) (Figure 2).
In the robotic surgery group, a total of 3 patients developed
lymphoresis in the femoral cannulation area during the postoperative
period, and recovery was achieved without the need for a major surgical
intervention. 3 in group I; 4 patients in group II were revised due to
bleeding(Table 3). In the postoperative period, neurological
complications developed in 1 (1.5%) patient in Group I and 2 (3.0%) in
Group II during the period that the patients spend in the hospital until
discharge; postoperative renal dysfunction developed in 6 (9.3%)
patients in Group I and 9 (13.6%) patients in Group II. Temporary
ultrafiltration was required in a total of 3 patients in Group II among
the patients with renal dysfunction.Pneumonia developed in 2 (3.1%)
patients in Group I and in 3 (4.5%) patients in Group II and clinical
improvement was achieved with medical treatment. Wound infection not
requiring surgical intervention was observed in 2 (3.1%) patients in
Group I and 3 (4.5%) patients in Group II. In patients with arrhythmia
in both groups, rhythm restoration was achieved with medication or
cardioversion in the postoperative period.