Establishing a Robotic Mitral Valve Surgery Program: Outcomes, Repair Success, and the Learning Curve

All articles of this category (opens in new window) Background: Robot-assisted mitral valve surgery represents the least invasive surgical approach for the treatment of mitral valve disease and has been shown to provide excellent outcomes. Establishing a robotic program, however, requires overcoming a significant learning curve, as well as careful stepwise implementation. Here, we present our initial experience with the introduction of a robotic mitral valve surgery program. Methods: We retrospectively analyzed our database of patients who underwent robotic mitral valve surgery from January 2024 to September 2025. Demographics, operative data, and early outcomes were reviewed to assess feasibility and safety during the early phase of program establishment. Results: A total of 51 patients underwent robotic mitral valve surgery during the study period. The mean patient age was 64 years, and the mean left ventricular ejection fraction (LVEF) was 58%. Of the cohort, 43 patients presented with primary mitral regurgitation, 7 with secondary mitral regurgitation, and 1 patient with mitral stenosis. In patients scheduled for repair, the reconstruction rate was 98%, while mitral valve replacement was performed as planned in three patients. The mean cross-clamp time was 105 minutes, and the mean total operative time was 250 minutes. Conversion to a larger incision was required in three cases: two to anterolateral thoracotomy and one to sternotomy. Postoperatively, one patient died, one patient required re-exploration due to hemothorax, and no neurological complications occurred. Conclusion: Robotic mitral valve surgery can be safely and effectively implemented with a high rate of successful repair and acceptable perioperative outcomes. Even during the early learning curve, the majority of patients underwent successful mitral valve reconstruction, and conversions or complications remained limited. These results demonstrate the feasibility of establishing a robotic mitral valve program with encouraging early outcomes. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany