Initial Experience With Robotic Mitral Valve Replacement: Results From a Single Centre

OBJECTIVES: Robot-assisted mitral valve replacement has been shown to be comparable to conventional surgery in terms of safety and efficacy. Our institution has performed robot-assisted mitral valve replacement using the Da Vinci Surgical System for over a decade. This study aimed to evaluate the time-related evolution of clinical outcomes and the impact of the surgical learning curve. METHODS: Patients who underwent robot-assisted mitral valve replacement between July 2013 and January 2024 were evaluated. All procedures were performed by 4 surgeons certified in robotic cardiac surgery, each with prior experience of more than 100 conventional mitral valve replacements. To assess the learning curve, cumulative sum analysis was conducted on cardiopulmonary bypass time and the Mitral Surgery Complexity Score. RESULTS: A total of 233 patients were included in the analysis. The mean patient age was 48.4 (13.9) years; 117 (50.2%) were male. The mean cardiopulmonary bypass time was 170.3 (55.1) min. Cumulative sum analysis of cardiopulmonary bypass time revealed 3 phases: a learning phase (cases 1-27), a proficiency phase (cases 28-92), and a mastery phase (cases 93 onward). Mitral Surgery Complexity Scores decreased during the early phase, followed by an increase after case 92, indicating a transition towards more complex cases. CONCLUSIONS: Robot-assisted mitral valve replacement has a measurable learning curve, with surgical efficiency and case complexity evolving over time. Approximately 93 procedures appear necessary to achieve operative stability and to confidently expand indications to include more complex patients.