Efficacy and Safety of Robot-Assisted and Sternotomy for Mitral Valve Repair in the Treatment of Mitral Regurgitation: A Systematic Review and Meta-Analysis

Background: Current research comparing the efficacy of robot-assisted mitral valve repair with sternotomy presents inconsistent results. This meta-analysis compares the advantages and disadvantages of robot-assisted mitral valve repair versus sternotomy, providing clinicians with a clearer reference for surgical decision-making. Methods: We systematically searched the PubMed, Embase, and Cochrane Library databases for studies published from inception to September 2021. Cohort studies were included where the observation group underwent robot-assisted surgery, and the control group received sternotomy. We excluded repeated publications, studies lacking full text, incomplete data, animal studies, and reviews/systematic reviews. Data were analyzed using STATA 15.1. Results: The pooled results showed that the operation time (weighted mean difference (WMD) = 43.95, 95% confidence interval (CI): 36.53- 51.36), aortic cross-clamp time (WMD = 26.72, 95% CI: 15.48-37.96), and cardiopulmonary bypass time (WMD = 39.50, 95% CI: 29.52-49.47) were significantly longer for robotic surgery compared to the sternotomy group. However, robotic surgery resulted in significantly shorter lengths of intensive care unit (ICU) stay (WMD = -25.43, 95% CI: -37.21-13.66) and hospital stay (WMD = -1.58, 95% CI: -2.26- -0.89) compared to sternotomy. The blood transfusion rate was significantly lower in the robotic surgery group (odds ratio (OR) = 0.66, 95% CI: 0.47-0.94). Furthermore, the mortality rate was significantly lower for robotic surgery (OR = 0.32, 95% CI: 0.17-0.60). Conclusion: Although robot-assisted mitral valve repair requires longer cross-clamp time, cardiopulmonary bypass time, and operation time compared to sternotomy, it results in shorter ICU and hospital stays, a lower blood transfusion rate, and a reduced mortality rate.