Short- and Mid-Term Outcomes of Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation in Octogenarians

Abstract

Background

Robotic mitral valve repair (r-MVr) offers potential advantages, but its safety and feasibility in patients aged ≥80 years remain unclear.

Methods and Results

This single-center retrospective cohort study included 53 consecutive patients aged ≥80 years who underwent MVr for degenerative mitral regurgitation between April 2011 and July 2025: 31 patients underwent r-MVr using the da Vinci Xi system, and 22 underwent conventional MVr (c-MVr). The primary outcomes were 30-day mortality, major complications, lengths of intensive care unit and hospital stay, and postoperative echocardiography findings. One 30-day death occurred after r-MVr (3.2%) due to intestinal ischemia, and none occurred after c-MVr. The postoperative hospital stay was shorter after r-MVr (12 [interquartile range (IQR), 8–13] vs. 13 [IQR, 12–15] days; P=0.04). The transmitral pressure gradient was lower in the r-MVr group than in the c-MVr group (2.1 [IQR, 2.0–3.0] vs. 3.0 [IQR, 2.0–3.9] mmHg; P=0.02). At the mid-term follow-up, there were no significant differences between the groups in 5-year overall survival (83.3% vs. 95.2%; P=0.32) or freedom from recurrent mitral regurgitation ≥ grade 3 (95.2% vs. 100%; P=0.49).

Conclusions

r-MVr can be a safe and feasible minimally invasive option with acceptable short- and mid-term outcomes in octogenarians.

Central Figure.

Over the past 2 decades, the definition of “elderly” in cardiology has gradually evolved: initially as those aged >70 years, then >75, and currently as those aged ≥80 years.^1–5 Life expectancy and quality of life among older individuals have continued to improve, but accompanied by an increasing prevalence of cardiovascular conditions, including mitral valve (MV) diseases. Consequently, an increasing number of patients aged ≥80 years are referred for cardiac surgery.^3,4

Robotic MV repair (r-MVr) has been associated with shorter intensive care unit (ICU) and hospital stays, reduced transfusion requirements, and lower rates of postoperative atrial fibrillation, while achieving mortality and reintervention rates comparable to those following conventional approaches.^5–11 These benefits have also been suggested in older patients. Analyses of data from the Society of Thoracic Surgeons database in the USA have shown similarly favorable postoperative outcomes in patients aged ≥65 years, with an increasing adoption of r-MVr in older populations.^5,12

However, data specifically focusing on patients aged ≥80 years remain limited, but given the ongoing demographic shift and potential benefits of less-invasive procedures in frail older patients, further investigation is warranted. In the present study, we aimed to evaluate the safety and feasibility of r-MVr in patients aged ≥80 years treated at an institution in Japan.

Methods

Study Cohort and Data Collection

This single-center, retrospective, comparative cohort study compared r-MVr with conventional MVr (c-MVr) in patients aged >80 years, who underwent primary MVr for degenerative mitral regurgitation (MR) at the National Cerebral and Cardiovascular Center Hospital between April 2001 and July 2025. After excluding 9 patients who underwent concomitant coronary artery bypass grafting and those with active infective endocarditis (none met this criterion), data of 53 patients were included in the final analysis. Among them, 31 underwent r-MVr using the da Vinci Surgical System Xi (Intuitive Surgical, Inc., Sunnyvale, CA, USA), while 22 underwent c-MVr via median sternotomy. The robotic program was introduced at the hospital in April 2018.

The perioperative and mid-term outcomes were compared between groups. The primary outcomes were 30-day mortality, major complications, length of ICU stay, length of postoperative hospital stay, and early postoperative echocardiographic findings. The secondary outcomes were mid-term results, including 5-year overall survival, freedom from recurrent MR ≥ grade 3, and freedom from functional mitral stenosis (MS), which was defined as a mean transmitral pressure gradient >5 mmHg.¹³

The indications for MVr were discussed by the institutional heart team, which comprised cardiologists, radiologists, and surgeons, and based primarily on published guidelines.¹³ The selection of r-MVr, c-MVr, or transcatheter edge-to-edge repair (M-TEER) was based on discussion considering anatomic suitability, comorbidities, surgical risk, and patient preference. Objective frailty scales, such as the clinical frailty scale, were not routinely used during the study period. r-MVr was contraindicated in patients with severe lung disease, severe peripheral arterial disease, calcification or dilatation of the aortic root and/or ascending aorta, moderate-to-severe aortic regurgitation, severe left ventricular dysfunction, coronary artery disease requiring revascularization, previous cardiac surgery, right-sided lung surgery, or severe endocarditis.^10,14,15 The converted case was analyzed according to the intention-to-treat principle and was included in the r-MVr group.

Data were retrospectively collected from medical charts and operative reports in September 2025.

Surgical Procedure

The surgical technique has been previously reported.^14–16 The skin incision was 4 cm, after which a camera port was inserted through the anterior 4th intercostal space at the incision site. Additional da Vinci ports were placed as follows: a left-hand instrument in the 3rd intercostal space, retractor in the 4th intercostal space, and right-hand instrument in the 6th intercostal space. All patients underwent mitral annuloplasty using a prosthetic full ring or partial band. Annuloplasty involved placing a series of equidistant 3-0 horizontal mattress sutures or running mattress sutures with 3-0 barbed sutures (V-Loc; Medtronic, Minneapolis, MN, USA). Annuloplasty device selection and sizing were not strictly based on protocol and were determined by the operating surgeon based on intraoperative anatomical assessment, primarily using the inter-trigone distance measured with the sizer without downsizing. When the intertrigonal distance was obscure, the length of the anterior leaflet was used to guide prosthesis sizing. The repair technique (resection and suture chordal replacement or edge-to-edge repair) depended on leaflet involvement.

Echocardiography

All patients underwent standard transthoracic echocardiography within 2 weeks preoperatively and within 2 weeks postoperatively in accordance with the hospital’s routine clinical practice guidelines. In addition, all patients underwent intraoperative transesophageal echocardiography to assess competency and flow through the MV. The MR grade was defined as 0, none; 1, trivial; 2, mild; 3, moderate; or 4, severe. Grade 4 MR was defined as either central jet MR >40% of the LA area, holosystolic eccentric jet MR, vena contracta width >0.7 cm, regurgitant volume >60 mL, regurgitant fraction >50%, or an effective regurgitant orifice >0.40 cm². Grade 3 MR was defined as: vena contracta width, 0.50–0.69 cm; regurgitant volume, 45–59 mL; regurgitant fraction, 40–49%; or an effective regurgitant orifice, 0.30–0.39 cm². Grade 2 MR was defined as: vena contracta width, 0.30–0.49 cm; regurgitant volume, 30–44 mL; regurgitant fraction, 30–39%; or an effective regurgitant orifice, 0.20–0.29 cm².¹³

Statistical Analysis

Categorical data are presented as number (%), and continuous data are presented as median and interquartile range (IQR). Categorical variables were compared using the chi-squared test or Fisher’s exact test, as appropriate. Continuous variables were compared using the t-test or Mann-Whitney U test, as appropriate. Mid-term outcomes were assessed using the Kaplan-Meier method; comparisons between groups were performed using the log-rank test. To account for the adjusted effects of risk factors of prolonged cardiac arrest time and hospitalization (≥14 days), a multiple regression model incorporating clinically relevant covariates was constructed. Regarding the analysis of prolonged cardiac arrest time, the model included robotic approach, age, concomitant surgery, complex repair (leaflet resection and/or chordal replacement), and prosthesis size. Considering the analysis of prolonged hospitalization, the model incorporated robotic approach, age, concomitant surgery, and preoperative serum creatinine levels. A two-sided P value <0.05 was considered statistically significant. All statistical analyses were performed using R software (version 4.2.1; The R Foundation for Statistical Computing, Vienna, Austria).

Results

Patients’ Characteristics and Preoperative Echocardiographic Findings

Baseline characteristics and preoperative echocardiographic findings are summarized in Table 1. In the c-MVr group, the median patient age was 82 years (IQR, 80–84 years). Female patients accounted for 61% and 41% of the patients in the r-MVr and c-MVr groups, respectively. Both groups had a median body surface area of 1.5 m² (IQR, 1.4–1.6). The prevalence of major comorbidities, including hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and atrial fibrillation, was comparable between the groups.

Table 1.

Patients’ Preoperative Characteristics

Variables	r-MVr (n=31)	c-MVr (n=22)	P value
Age (years)	81 (81, 83)	82 (80, 84)	0.57
Female	19 (61%)	8 (36%)	0.10
BSA (m2)	1.5 (1.4, 1.6)	1.5 (1.4, 1.6)	0.90
NYHA ≥3	4 (13%)	1 (4.5%)	0.39
Hypertension	24 (77%)	12 (55%)	0.13
Dyslipidemia	10 (32%)	7 (32%)	1.00
Diabetes mellitus	0 (0%)	1 (4.5%)	0.42
COPD (FEV1.0% <70%)	7 (30%)	7 (32%)	1.00
Atrial fibrillation	7 (23%)	8 (36%)	0.36
Hemodialysis	1 (3.3%)	1 (4.5%)	0.36
Echocardiography
LVEF (%)	61 (55, 66)	64 (59, 68)	0.22
LVDD (mm)	52 (48, 55)	56 (50, 62)	0.08
LVDS (mm)	34 (29, 37)	35 (28, 40)	0.64
LAD (mm)	49 (44, 51)	51 (46, 54)	0.08
MR grade (grade 0–4)	4 (3, 4)	4 (4, 4)	0.44
TR grade (grade 0–4)	2 (1, 2)	1 (1, 2)	0.29
TRPG (mmHg)	31 (25, 37)	39 (29, 45)	0.12
Prolapse site
Anterior leaflet only	3 (9.7%)	3 (14%)	0.68
Posterior leaflet only	21 (68%)	12 (55%)	0.40
Bilateral leaflet	4 (13%)	1 (4.5%)	0.39
Commissure leaflet	3 (9.7%)	5 (23%)	0.25

Continuous variables are presented as median (IQR); categorical variables are presented as number (%). Continuous variables are presented as medians (interquartile range [IQR]), while categorical variables are presented as numbers (%). BSA, body surface area; c-MVr, conventional mitral valve repair; COPD, chronic obstructive pulmonary disease; FEV, forced expiratory volume; IQR, interquartile range; LAD, left atrial diameter; LVDD, left ventricular diastolic diameter; LVDS, left ventricular systolic diameter; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; NYHA, New York Heart Association functional class; r-MVr, robotic mitral valve repair; TR, tricuspid regurgitation; TRPG, tricuspid regurgitation pressure gradient.

The median left ventricular ejection fraction was 61% (IQR, 55–66%) in the r-MVr group and 64% (IQR, 59–68%) in the c-MVr group. The median left ventricular end-diastolic dimension was 52 mm (IQR, 48–55 mm) in the r-MVr group vs. 56 mm (IQR, 50–62 mm) in the c-MVr. The median end-systolic dimension was 34 mm (IQR, 29–37 mm) in the r-MVr group vs. 35 mm (IQR, 28–40 mm) in the c-MVr. The median left atrial diameters were 49 mm (IQR, 44–51 mm) and 51 mm (IQR, 46–54 mm) in the r-MVr and c-MVr groups, respectively. Posterior leaflet prolapse was the most common lesion in both groups (68% and 55% in the r-MVr and c-MVr groups, respectively), followed by anterior (9.7% and 14%), commissural (9.7% and 23%), and bileaflet prolapses (13% and 4.5%).

Surgical Details

Surgical details are summarized in Table 2. Leaflet resection was performed less frequently in the r-MVr group than in the c-MVr group (36% vs. 68%; P=0.03). Chordal replacement (65% vs. 27%; P=0.01) and use of a partial annuloplasty band (97% vs. 46%; P<0.001) were more common in the r-MVr group than in the c-MVr. The prosthesis was significantly larger in the r-MVr group than in the c-MVr group (30 [IQR, 28–32] mm vs. 28 [IQR, 27–30] mm; P=0.02). Concomitant tricuspid annuloplasty (26% vs. 64%, P=0.01) and maze procedures (23% vs. 55%, P=0.01) were performed more frequently in the c-MVr group than in the r-MVr. The cardiopulmonary bypass time was comparable between groups (119 [IQR, 100–142] min vs. 117 [IQR, 104–144] min; P=0.86), but the aortic cross-clamp time was significantly shorter in the r-MVr group than in the c-MVr group (73 [IQR, 58–87] min vs. 91 [IQR, 75–112] min; P=0.02). Using multiple regression analysis (Table 3), the robotic approach remained independently associated with a shorter aortic cross-clamp time (β=−20.3 min; P=0.021), even after adjusting for age, concomitant surgery, complexity of leaflet repair, and prosthesis size.

Table 2.

Surgical Details

Variables	r-MVr (n=31)	c-MVr (n=22)	P value
Leaflet resection	11 (36%)	15 (68%)	0.03*
Chordal replacement	20 (65%)	6 (27%)	0.01*
Partial band	30 (97%)	10 (46%)	<0.001*
Prosthesis size (mm)	30 (28, 32)	28 (27, 30)	0.02*
Concomitant surgery
Tricuspid valve repair	8 (26%)	14 (64%)	0.01*
Maze procedure	7 (23%)	12 (55%)	0.01*
LAA closure	10 (32.3%)	8 (36.4%)	0.78
PFO closure	1 (3.2%)	0 (0%)	1.00
CPB time (min)	119 (110, 142)	117 (104, 144)	0.86
AXC time (min)	73 (58, 87)	91 (75, 112)	0.02*

Continuous variables are presented as median (IQR); categorical variables are presented as number (%). *P<0.05. AXC, aorta cross-clamp time; CPB, cardiopulmonary bypass; LAA, left atrial appendage; PFO, patent foramen ovale. Other abbreviations as in Table 1.

Table 3.

Multiple Regression Analysis of Predictors of Prolonged AXC

Variables	β	95% CI	P value
Robotic approach	−20.3	−37.5 to −3.1	0.021*
Age (per 1-year increase)	−4.4	−8.2 to −0.7	0.022*
Concomitant surgery	16.2	−0.3 to 32.7	0.053
Complex repair (leaflet resection and chordal replacement)	29.6	−5.0 to 64.3	0.091
Prosthesis size (per 1 mm increase)	3.4	−0.3 to 7.1	0.068

*P<0.05. AXC, aorta cross-clamp time; CI, confidence interval.

Short-Term Outcomes and Early Postoperative Echocardiographic Findings

Short-term outcomes and postoperative echocardiographic findings are summarized in Table 4. One 30-day death occurred in the r-MVr group due to intestinal ischemia caused by superior mesenteric artery embolization secondary to new-onset atrial fibrillation on postoperative day (POD) 12, despite prompt initiation of anticoagulation therapy. One patient undergoing r-MVr required in-hospital reintervention for hemolytic anemia caused by recurrent grade 3 MR on POD 7. None of the patients undergoing c-MVr required reoperation (P=1.00) during hospitalization. The median ICU stay was similar between groups (2 [IQR, 2–3] days; P=0.81), but the postoperative hospital stay was significantly shorter in the r-MVr group (12 [IQR, 8–13] days vs. 13 [IQR, 12–15] days; P=0.04). Using multiple logistic regression analysis (Table 5), the robotic approach remained independently associated with a significantly lower risk of prolonged hospitalization (≥14 days) (odds ratio, 0.22; P=0.049); age and preoperative serum creatinine were not significant predictors. Concomitant surgery was also associated with a lower likelihood of prolonged hospitalization (odds ratio, 0.21; P=0.043).

Table 4.

In-Hospital Outcomes and Postoperative Echocardiographic Findings

Variables	r-MVr (n=31)	c-MVr (n=22)	P value
30-day mortality	1 (3.2%)	0 (0%)	1.00
Reoperation for recurrent MR	1 (3.2%)	0 (0%)	1.00
ICU length of stay	2 (2, 3)	2 (2, 3)	0.81
Hospital length of stay	12 (8, 13)	13 (12, 15)	0.04*
Complications
MCS support	0 (0%)	1 (4.5%)	0.42
Dissection	0 (0%)	0 (0%)	NA
Stroke	1 (3.2%)	1 (4.5%)	1.00
AMI	0 (0%)	0 (0%)	NA
Respiratory failure	0 (0%)	2 (9.1%)	0.17
PMI	0 (0%)	1 (4.5%)	0.42
Bleeding requiring reoperation	0 (0%)	2 (9.1%)	0.17
Paroxysmal AF	11 (36%)	10 (46%)	0.57
Echocardiography
MR grade (0–4)	0.5 (0.5, 0.5)	0.5 (0, 1)	0.17
None or trivial	30 (97%)	20 (96%)	1.00
Mild	1 (3.2%)	1 (4.5%)
Trans mitral mean PG (mmHg)	2.1 (2.0, 3.0)	3.0 (2.0, 3.9)	0.02*
>5 mmHg	0 (0%)	4 (18.2%)	0.03*

Continuous variables with a non-normal distribution are presented as median (IQR), whereas categorical variables were presented as numbers (%). *P<0.05. AF, atrial fibrillation; AMI, acute myocardial infarction; ICU, intensive care unit; MCS, mechanical circulatory support; PG, pressure gradient; PMI, pacemaker implantation. Other abbreviations as in Table 1.

Table 5.

Multiple Logistic Regression Analysis of Predictors of Prolonged Hospitalization (≥14 Days)

Variables	OR	95% CI	P value
Robotic approach	0.22	0.1 to 1.0	0.049*
Age (per 1-year increase)	0.85	0.6 to 1.2	0.317
Concomitant surgery	0.21	0.1 to 1.0	0.043*
Preoperative serum creatinine (per 1.0 mg/dL increase)	0.68	0.2 to 2.3	0.530

*P<0.05. CI, confidence interval; OR, odds ratio.

Major complications, including the need for mechanical circulatory support, stroke, and respiratory failure, were infrequent and did not differ significantly between groups. One patient in the c-MVr group required mechanical circulatory support and 2 required re-exploration for bleeding, whereas none in the r-MVr group required any interventions (P=0.42 and 0.17, respectively). New-onset paroxysmal atrial fibrillation occurred in 36% and 46% of patients undergoing r-MVr and c-MVr, respectively (P=0.57). During the attempted r-MVr in 1 patient, leaflet fragility precluded durable repair, requiring conversion to MVr via median sternotomy.

Early postoperative echocardiography demonstrated excellent results in both groups, with either none or trivial MR observed in 97% of the patients undergoing r-MVr and 96% of the patients undergoing c-MVr. The transmitral mean pressure gradient was significantly lower in the r-MVr group (2.1 [IQR, 2.0–3.0] mmHg vs. 3.0 [IQR, 2.0–3.9] mmHg; P=0.02). None of the patients in the r-MVr group had a gradient >5 mmHg, whereas 18% of those in the c-MVr group did (P=0.03).

Mid-Term Outcomes

During the follow-up period, late death occurred in 9 of the 52 survivors (17.3%). The causes of death were cerebral infarction in 1 patient, aspiration pneumonia in 6, lung cancer in 1, and unknown in 2. At a median follow-up of 3.6 years (IQR, 2.3–4.8) after r-MVr and 7.5 years (IQR, 6.2–9.1) after c-MVr, the 5-year survival rate was 83.3% after r-MVr and 95.2% after c-MVr (P=0.32) (Figure 1A). Similarly, the 5-year freedom from recurrent MR ≥ grade 3 was 95.2% after r-MVr and 100% after c-MVr (P=0.49) (Figure 1B).

Figure 1.

Kaplan-Meier curves for (A) overall survival after robotic (r-MVr) and conventional mitral valve repair (c-MVr), (B) freedom from recurrent mitral regurgitation (≥ grade 3) after r-MVr and c-MVr and (C) from functional mitral stenosis (MS) after r-MVr and c-MVr in octogenarians. Functional MS defined as a mean transmitral pressure gradient >5 mmHg.

In addition, the freedom rate from functional MS was significantly higher in the r-MVr group, with a 5-year freedom rate of 91.8%, compared with 72.7% in the c-MVr group (P=0.04) (Figure 1C).

Discussion

In the present study of MVr in octogenarians, r-MVr yielded short- and mid-term outcomes comparable to those following c-MVr, with no apparent increase in deaths or major complications compared with c-MV and with a significantly shorter postoperative hospital stay. These findings indicate that with appropriate patient selection and perioperative management, r-MVr could be performed safely and feasibly even in very old individuals.

Previous studies have reported that advanced age alone does not preclude robotic mitral surgery. Sawma et al.¹⁷ and Ranganath et al.¹⁸ demonstrated favorable outcomes in patients aged ≥65 and ≥75 years, respectively, and Minol et al.¹⁹ reported excellent results for minimally invasive MV surgery in octogenarians. Although data on r-MVr in octogenarians are limited, our findings support its feasibility and safety in this patient population.

In the present study, both approaches yielded satisfactory outcomes, with no apparent increase in deaths or major complications in the r-MVr group compared with c-MVr. One in-hospital death occurred in the r-MVr group, related to intestinal ischemia secondary to postoperative atrial fibrillation, although the incidence of new-onset atrial fibrillation was similar in both groups. Cases of postoperative intestinal ischemia, intraoperative conversion, and reoperation for hemolysis were observed in the r-MVr group; however, these events appeared to be related to patient- or lesion-specific factors rather than the robotic approach itself.

Consistent with the findings in previous reports, our study also demonstrated a significantly shorter postoperative hospital stay in the r-MVr group, highlighting a clear benefit of the robotic approach for managing older patients, who often benefit from early mobilization and reduced postoperative stress. This advantage might, in part, reflect the shorter aortic cross-clamp time associated with the robotic approach. Notably, the higher rates of maze procedures and tricuspid annuloplasty in the c-MVr group, which differ substantially in surgical complexity, likely contributed to the longer aortic cross-clamp time and should not be attributed solely to the surgical approach.

With respect to mid-term outcomes, overall survival was comparable between groups, with a 5-year survival rate of 83.3% after r-MVr. Freedom from recurrent MR ≥ grade 3 reached 95.2% after r-MVr, indicating satisfactory repair durability even in this advanced-age population. However, given the shorter follow-up duration and the limited number of patients at risk beyond 5 years in the r-MVr group, conclusions regarding mid-term durability should be interpreted with caution.

Importantly, the higher freedom from functional MS in the r-MVr group may be partly explained by the more frequent use of partial annuloplasty bands and larger prosthesis sizes, rather than by the robotic approach itself. However, technical aspects of the robotic approach may also have contributed to these findings.

One of the key findings of the present study was the lower transmitral pressure gradient observed in the r-MVr group, with all cases remaining below the threshold for functional MS. In a previous report of our institutional experience, we reported that annuloplasty with a small ring during MVr resulted in functional MS, associated with increased pulmonary arterial pressure, residual tricuspid regurgitation, and new-onset atrial fibrillation.²⁰ Consistently, Kim et al. demonstrated that functional MS increased the risk of new-onset atrial fibrillation and mitral valve reoperation and decreased long-term survival.²¹ In this context, the low transmitral gradients observed after r-MVr in the present study suggest favorable postoperative valve hemodynamics in this advanced-age population and may be clinically meaningful in this vulnerable patient group.

As the population ages, and mitral interventions become less invasive, defining the roles of r-MVr and M-TEER will increasingly become important. Recent comparative studies of MVr and M-TEER in octogenarians have shown that MVr is associated with a lower rate of recurrent MR and superior survival, whereas M-TEER provides faster recovery at the expense of long-term durability.^22,23 In this context, r-MVr is a minimally invasive yet durable option for octogenarians when surgical indications are met and institutional expertise is available.

Study Limitations

First, this was a retrospective single-center analysis with a relatively small sample size, which might limit the generalizability of the findings. In addition, the baseline characteristics of the r-MVr and c-MVr groups were not matched. Propensity score matching was not feasible due to the limited sample size and the highly selected cohort, and therefore residual confounding cannot be excluded. Second, the follow-up was shorter in the r-MVr group than in the c-MVr group, which might have affected the assessment of mid-term outcomes. This difference reflects the recent introduction of robotic approaches in 2018, and therefore the r-MVr and c-MVr cohorts represent different surgical eras (Figure 2). Improvements in perioperative management, discharge practices, and surgical strategies over time may have contributed to the observed differences in outcomes. Third, although the surgical approach was theoretically influenced by institutional contraindications for r-MVr, none of the patients met the institutional contraindications for r-MVr and subsequently underwent c-MVr. Fourth, concomitant tricuspid annuloplasty and maze procedures were performed less frequently in the r-MVr group, which may have influenced the perioperative outcomes. In addition, the multivariable model may have been subject to overfitting due to the limited sample size, and the observed association between concomitant surgery and shorter hospitalization should be interpreted with caution. Finally, this study did not include a direct comparison with M-TEER. Given the growing role of M-TEER in older patients with degenerative MR, future multicenter analyses that directly compare both of these less invasive modalities are warranted to better define their respective indications and determine their long-term comparative effectiveness.

Figure 2.

Bar graph showing the annual number of patients undergoing robotic mitral valve repair (r-MVr) and conventional mitral valve repair (c-MVr) during the study period. The r-MVr program was introduced in 2018, and accordingly, the r-MVr cohort predominantly reflects the post-2018 era, whereas the c-MVr cohort includes a larger proportion of earlier-era cases.

Conclusions

In octogenarians, r-MVr provided short- and mid-term outcomes comparable to those following c-MVr, with the additional benefit of a shorter postoperative hospital stay. These results support the safety and feasibility of r-MVr in older patients and warrant further investigation in larger multicenter cohorts.

Disclosures

The authors declare that there are no conflicts of interest.

IRB Information

Prior to surgery, all patients provided written informed consent for the surgery and use of their data for research purposes. This study was approved by the National Cerebral and Cardiovascular Center Institutional Review Board (reference number: M30-026).

Data Availability

Due to privacy and institutional restrictions, the clinical datasets used in this study are not publicly available. De-identified data may be available from the corresponding author upon reasonable request and with approval from the Institutional Review Board.