Patients’ choice for robotically assisted mitral valve replacement is still debated. Researchers looked at the results of a conservative screening algorithm created to identify individuals with degenerative mitral valve disease who would benefit from robotic surgery. Three surgeons used a screening algorithm that included transthoracic echocardiography. They computed tomography scanning to assess the candidacy of 1000 consecutive patients with isolated degenerative mitral valve disease (age 58 ± 11 years, 67% male) for robotic surgery from January 2014 to January 2019. Those chosen for robotic versus sternotomy techniques had their screening results and hospital outcomes evaluated. 

The screening process resulted in the selection of 605 patients for robotic surgery. Aortoiliac atherosclerosis (n=74/292, 25%), femoral artery diameter 7 mm (n=60/292, 20%), mitral annular calcification (n=83/390, 21%), aortic regurgitation (n=100/391, 26%), and reduced left ventricular function (n=126/391, 32%) were the most common reasons for sternotomy (n=395). In 996, the mitral valve was repaired. Patients who underwent robotic surgery had a lower rate of new-onset atrial fibrillation (n=144/582, 25% vs n=125/373, 34%; P=.002), fewer red blood cell transfusions (n=61/601, 10% vs 69/395, 17%; P=.001), and a shorter hospital stay (5.2 ± 2.9 days vs 5.9 ± 2.1 days; P.=001).