Minimally invasive mitral valve repair or replacement may offer a better value than robotic procedures, researchers reported April 30 at the American Association for Thoracic Surgery meeting in Toronto.

Mohammed Hassan, MD, of the University of New Mexico in Albuquerque, and colleagues conducted a cost-benefit comparison of minimally invasive mitral valve repair or replacement and robotic mitral valve repair or replacement based on a literature review. They identified 21 studies to compare outcomes and three studies combined with their institutional experience to compare costs.

They calculated costs in excess of conventional mitral valve repair or replacement costs. In that context, the total cost per case for robotic procedures was $3,911 with volumes of 50 cases a year. Costs dropped as volume increased, to $2,985 per case at a volume of 100 cases a year.

Minimally invasive procedures, on the other hand, cost much less: $259 per case with a volume of 50 cases per year and $169 per case with a volume of 100 cases a year.

Minimally invasive mitral valve repair or replacement and robotic mitral valve repair or replacement offered similar clinical benefit, the researchers found. The mean 30-day mortality rate was 1.24 percent for minimally invasive procedures vs. 0.55 percent for robotic procedures and the rate of neurological events was 1.32 percent and 2.37 percent, respectively. 

Larger proportions of patients who underwent robotic procedures were converted to conventional mitral valve repair or replacement and had postoperative atrial fibrillation compared with patients in the minimally invasive group.

Length of stay (LOS) was longer in the minimally invasive group, at 7.78 days vs. 5.54 days for the robotic group, but that variable was skewed by one European study that reported LOS with the minimally invasive procedure of 12.4 days.

While increasing volume lowered the cost of a robotic mitral valve repair or replacement, the gap in marginal costs between the two approaches remained substantial.