Objectives We compared the clinical outcomes of mitral valve (MV) repair for mitral regurgitation via robot-assisted approach (ROBO) and small right thoracotomy approach (MINI) three years after the reimbursement of ROBO in Japan. Methods Patients who underwent isolated MV repair by minimally invasive approach between 2018 and 2020 from the Japanese Cardiovascular Surgery Database were included. Patients in the ROBO group were matched to the MINI group based on propensity scores estimated from patient and surgical characteristics. Perioperative outcomes were compared among all as well as in subgroups categorized based on the yearly number of ROBO or MINI cases (≥10 or not) at the hospital. Results We identified 2,443 patients who had undergone isolated MV repair at 250 institutions in the database, and analysis of propensity matched 577 patient-pairs demonstrated that operation time, cardiopulmonary bypass time, and aortic cross clamp time were significantly shorter in ROBO. Although the ICU stay was longer in ROBO, the time to discharge was significantly shorter in ROBO. There was no meaningful difference in in-hospital mortality. The incidence of postoperative stroke, renal failure, prolonged ventilation, and the number of patients who cinverted to MV replacement were similarly low. Procedural time, blood transfusions, explorative procedures for bleeding, postoperative stroke, and prolonged ventilation occurred at a lower rate in the high-volume institutions. Conclusions The study found that ROBO is just as effective as MINI. The introduction of robot-assisted MV repair in Japan has been successful. We compared the clinical outcomes of mitral valve (MV) repair for mitral regurgitation via robot-assisted approach (ROBO) and small right thoracotomy approach (MINI) three years after the reimbursement of ROBO in Japan. Patients who underwent isolated MV repair by minimally invasive approach between 2018 and 2020 from the Japanese Cardiovascular Surgery Database were included. Patients in the ROBO group were matched to the MINI group based on propensity scores estimated from patient and surgical characteristics. Perioperative outcomes were compared among all as well as in subgroups categorized based on the yearly number of ROBO or MINI cases (≥10 or not) at the hospital. We identified 2,443 patients who had undergone isolated MV repair at 250 institutions in the database, and analysis of propensity matched 577 patient-pairs demonstrated that operation time, cardiopulmonary bypass time, and aortic cross clamp time were significantly shorter in ROBO. Although the ICU stay was longer in ROBO, the time to discharge was significantly shorter in ROBO. There was no meaningful difference in in-hospital mortality. The incidence of postoperative stroke, renal failure, prolonged ventilation, and the number of patients who cinverted to MV replacement were similarly low. Procedural time, blood transfusions, explorative procedures for bleeding, postoperative stroke, and prolonged ventilation occurred at a lower rate in the high-volume institutions. The study found that ROBO is just as effective as MINI. The introduction of robot-assisted MV repair in Japan has been successful.

Successful launch of robot-assisted mitral valve repair in Japan under universal health coverage