Robot-Assisted Mitral Valve Repair versus Conventional Sternotomy versus Minimally Invasive Procedure for Degenerative Mitral Regurgitation: A Systematic Review and Network Meta-Analysis of Intra-Hospital Mortality and Myocardial Infarction
Abstract Body (Do not enter title and authors here):
Introduction Degenerative mitral regurgitation (DMR) is a common valvular heart disease requiring surgical intervention. While conventional sternotomy (CS) has been the traditional approach, minimally invasive procedures (MIP) and robot-assisted surgery (RAS) have emerged as alternatives. However, comprehensive comparisons of their perioperative safety profiles remain limited. This network meta-analysis (NMA) evaluates intra-hospital mortality and myocardial infarction (MI) rates among these three surgical approaches. Research Question What are the comparative outcomes of CS, MIP, and RAS in terms of intra-hospital mortality, intra-hospital MI, intra-hospital acute renal failure (ARF), and length of hospital stay (LOS) in patients with DMR? Methodology We conducted a Bayesian NMA using a random-effects model, synthesising data from 15 studies (n=12,247 patients). The analysis included direct and indirect comparisons between RAS, CS, and MIP. Primary outcomes were 30-day mortality and stroke, with secondary outcomes of ARF and LOS. We calculated odds ratios (OR) with 95% credible intervals (CrI) and ranked treatments using surface under the cumulative ranking curve (SUCRA) probabilities. Multi-criteria decision analysis (MCDA) was used to rank interventions on the basis of all outcomes. Results Our NMA included 11 studies involving 12,247 patients. RAS demonstrated superior performance across all measured endpoints, with a 37% reduction in 30-day mortality compared to CS (OR 0.63, 95% CrI 0.41-0.97) and a 17% reduction versus MIP (OR 0.83, 95% CrI 0.55-1.25) (SUCRA= RAS: 80.3%, MIP: 57.1%, CS: 12.6%). For renal complications, RAS showed a 39% risk reduction versus CS (OR 0.61, 95% CrI 0.41-0.90) and 36% versus MIP (OR 0.64, 95% CrI 0.43-0.94), with SUCRA probabilities of 88.9%, 54.7%, and 6.4%, respectively. Myocardial infarction rates did not differ significantly between techniques (RAS vs CS OR 0.70, 95% CrI 0.35-1.41), though RAS maintained the highest probability of being safest (SUCRA 74.6%). Conclusion This comprehensive NMA demonstrates that RAS for degenerative mitral valve repair offers the most favourable perioperative outcomes, with significant reductions in mortality, renal complications compared to CS. MIP present a viable alternative when robotics is unavailable. These findings support the adoption of robotic approaches where feasible. Keywords:. Robot-Assisted Surgery; Conventional Sternotomy; Minimally Invasive Procedure; Mitral Valve Repair
Bin Zahid, Muhammad Maaz
( Khyber Medical College
, Peshawar
, Pakistan
)
Salahuddin, Aleena
( Khyber Medical College
, Peshawar
, Pakistan
)
Shah, Muhammad Asim
( Khyber Medical College
, Peshawar
, Pakistan
)
Noor, Muhammad Sanaan
( Khyber Medical College
, Peshawar
, Pakistan
)
Uddin, Misbah
( Khyber Medical College
, Peshawar
, Pakistan
)
Khan, Suleman
( Khyber Medical College
, Peshawar
, Pakistan
)
Author Disclosures:
Muhammad Maaz Bin Zahid:DO NOT have relevant financial relationships
| Aleena Salahuddin:No Answer
| Muhammad Asim Shah:DO NOT have relevant financial relationships
| Muhammad Sanaan Noor:DO NOT have relevant financial relationships
| Misbah uddin:No Answer
| Suleman Khan:DO NOT have relevant financial relationships
