Mid-term Outcomes of Robotic Assisted versus Conventional Sternotomy for Mitral Valve Replacement: Inverse Probability of Treatment Weighting Survival Analysis

Background This study aimed to compare survival, complications, and healthcare costs between robotic-assisted and conventional sternotomy mitral valve replacement, using a nationwide population-based dataset from Taiwan. Methods Patients who underwent isolated surgical mitral valve replacement between 2016 and 2021 were identified from Taiwan’s National Health Insurance Research Database. Inverse probability of treatment weighting was used to adjust for baseline differences. Survival, postoperative complications, and medical costs were compared between the two surgical approaches. Results After adjustment, a total of 5,660 patients who underwent conventional sternotomy and 5640 who received robotic-assisted mitral valve replacement were used for analysis. The robotic-assisted group had significantly better survival (hazard ratio: 0.37, 95% confidence interval: 0.33–0.41, p  < 0.01), shorter hospital stays (16.5 vs. 22.7 days, p  < 0.01), shorter intensive care stays (4.4 vs. 9.1 days, p  < 0.01), and lower rates of dialysis and stroke. The additional medical expenses incurred within one year after surgery, excluding the cost of the initial hospitalization, were also significantly lower in the robotic-assisted group (1,640 vs. 4,003 United States dollars, p  < 0.01). Conclusion In this national population-based analysis, robotic-assisted mitral valve replacement was associated with better mid-term survival, shorter hospital stays, and reduced medical costs compared with conventional sternotomy. These findings support the use of robotic-assisted surgery as a safe and effective alternative in selected patients undergoing mitral valve replacement.