Comparative Study Of Clinical Effects Of Da Vinci Robot-assisted And Conventional Thoracotomy Mitral Valve Replacement

Objective : Using the propensity score matching method,we compared the perioperative data of patients undergoing Da Vinci robotic-assisted and conventional thoracotomy mitral valve replacement to identify the unique features of the roboticassisted surgical system and the areas that still need improvement to promote the future application of the Da Vinci robot in the field of cardiac surgery.Methods: A total of 282 patients with mitral valve replacement surgery performed at the Affiliated Hospital of Qingdao University from January 2018 to January 2022 were collected,including 70 patients with Da Vinci robotic-assisted mitral valve replacement surgery,named the Da Vinci group,and 212 patients with conventional thoracotomy mitral valve replacement surgery,named the conventional group.The perioperative data of both groups were counted,including preoperative data: age,gender,BMI,smoking history,alcohol history,biochemical test results,previous medical history(including hypertension,diabetes,cerebral infarction,peripheral vascular embolism,coronary artery disease,atrial fibrillation,etc.);Intraoperative data: surgical time,extracorporeal circulation time,aortic occlusion time,intraoperative bleeding volume;Postoperative data:tracheal intubation time,postoperative ICU time,postoperative hospitalization time,whether blood was transfused after surgery,postoperative drainage volume,incidence of postoperative complications,total hospitalization cost,and improvement of symptoms at the 1-month postoperative review.Propensity score matching analysis was generated for data from both groups of patients to eliminate the effect of relevant confounding factors,and all data were statistically analyzed using SPSS software to compare whether the data of the two sets were statistically different(P value greater or less than 0.05).Results : Patients in both the Da Vinci and conventional groups completed the surgery successfully and were discharged after satisfactory postoperative cardiac function review,with no in-hospital deaths.After propensity score matching,there was no statistical difference between the Da Vinci group(70 patients)and the conventional group(70 patients)in terms of preoperative baseline characteristics(P > 0.05).The operative time,extracorporeal circulation time,and aortic block time of patients in the Da Vinci group were significantly longer than those in the conventional group,and the differences were statistically significant(P < 0.001).Intraoperative bleeding,postoperative tracheal intubation time,postoperative ICU stay,postoperative chest drainage,and postoperative hospital stay were all reduced in patients in the Da Vinci group compared with the conventional group,and the differences were statistically significant(P < 0.001).There was no statistical difference in the chance of postoperative complications of pleural effusion,incisional infection,lower limb venous embolism,and secondary thoracotomy exploration between the two groups(P > 0.05).Three(4.3%)patients in the Da Vinci group developed postoperative pulmonary infection,and 11(15.7%)patients in the conventional group developed pulmonary infection,and the chance of developing pulmonary infection after surgery increased in the conventional group compared with the Da Vinci group(P<0.05).There was no statistical difference in the LVEF between the patients in the Da Vinci and conventional groups at the 1-month postoperative review(P> 0.05),and both groups showed improvement in symptoms compared with the preoperative period.Total hospitalization costs were significantly higher in the Da Vinci group compared with the conventional group(P<0.001).Conclusion:Da Vinci robotic-assisted mitral valve replacement is comparable to conventional thoracotomy mitral valve replacement in terms of surgical safety and feasibility,and does not increase the incidence of postoperative complications.In addition,Da Vinci robot-assisted mitral valve replacement is significantly superior to conventional thoracotomy mitral valve replacement in terms of postoperative recovery,but its longer operating time,extracorporeal circulation time and aortic occlusion time,as well as higher hospital costs warrant continued improvement in the future.