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.