Outcomes of robotic and endoscopic combined aortic and mitral valve surgery: experience from National Taiwan University Hospital

Abstract

Background: Minimally invasive approaches in cardiac surgery have transformed the field by reducing surgical trauma and improving recovery outcomes. The lateral approach, using robotic and endoscopic technologies, offers superior visualization for complex procedures, such as combined aortic and mitral valve surgery. Addressing concurrent pathologies in the aortic and mitral valves increases procedural complexity, requiring precise techniques and optimal patient selection. Methods: This retrospective, single-center study evaluated adult patients who underwent robotic or endoscopic combined aortic and mitral valve surgery between January 2015 and November 2024. Data on patient demographics, perioperative details, and postoperative outcomes including complications, mortality rates, and improvements in New York Heart Association (NYHA) functional status were analyzed. Results: A total of 67 patients were included, with 8 undergoing robotic and 59 endoscopic procedures. No mortality or conversion to open surgery was observed. Postoperative complications were minimal, with a low infection rate of 1.5% and an atrial fibrillation rate of 26.8%. Over 85% of patients experienced significant improvement in NYHA functional status. Conclusions: Robotic and endoscopic combined aortic and mitral valve surgery using the lateral approach is safe and effective, yielding excellent outcomes in a well-selected patient population.