Outcomes of robotic repair for the degenerative mitral valve: a systematic review and meta-analysis

Background: Robotic mitral valve repair (RMVr) provides a minimally invasive option for degenerative mitral regurgitation (MR), yet durability signals and patient outcomes remain heterogeneously reported. This current systematic review and meta-analysis aims to summarize survival and freedom from reoperation following RMVr in degenerative disease.Methods: Five databases were searched from inception through July 2025 for studies reporting RMVr outcomes in degenerative disease. Cohorts with mixed etiologies without separable data were excluded. Short-term mortality (<30 days) was the primary outcome, while mid- to long-term survival and freedom from reoperation were presented using Kaplan-Meier curves. Secondary endpoints included relevant morbidity outcomes and reoperation rates. Meta-regression analysis examined associations between cohort size and adverse outcomes and assessed temporal trends in RMVr technique.Results: Following independent screening, 15 studies were selected, including 11,432 patients. Pooled mean follow-up was 60.9 months (clinical) and 20.0 months (echocardiographic). Kaplan-Meier overall survival at 1, 3, 5 and 10 years was 98.9%, 98.7%, 97.4% and 92.3%, respectively. At 1, 3 and 5 years, freedom from reoperation was 97.7%, 96.0% and 96.0%, while freedom from recurrent ≥2+ MR was 98.3%, 95.8% and 95.8%. Pooled short-term (<30 days) mortality was 1.3% [95% confidence interval (CI): 1.1–1.4%]. Postoperative morbidity was low, with cerebrovascular accident (CVA) in 1.4% and acute kidney injury (AKI) in 1.3%. Reoperation for bleeding and valve dysfunction occurred in 2.3% and 2.2% of patients, respectively. Pooled mean intensive care unit (ICU) stay was 1.2 days and hospital length of stay (LOS) was 6.0 days. Meta-regression suggested increasing adoption of neochordae techniques over time (P=0.015). Heterogeneity was high for several parameters, reflecting differences in study design, surgeon experience, and follow-up duration.Conclusions: In degenerative mitral disease, RMVr demonstrates low short-term mortality and complications, with favorable mid- to long-term durability, including high freedom from recurrent moderate-to-severe MR and reoperation. These findings support RMVr as an effective and durable surgical approach to degenerative mitral pathology, underscoring the need for prospective, standardized studies with robust echocardiographic follow-up and case-mix adjustment.