目的：利用倾向性评分匹配法对比机器人辅助与常规正中开胸二尖瓣成形术的手术情况与围手术期 结局。方法：回顾性分析 2016 年 6 月—2021 年 12 月于首都医科大学附属北京安贞医院行单纯二尖瓣成形术的 379 例患者记作总体人群。根据手术的入路方式分为两组，即观察组（n=122，行机器人辅助手术）和对照组（n=257， 行传统正中开胸手术）。利用倾向性评分，两组各选出 109 例患者进行匹配，记作匹配人群。总体人群和匹配人群 分别对比手术情况、围手术期结局事件发生情况。结果：总体人群中，观察组患者的手术时间、体外循环时间、主 动脉阻断时间均长于对照组，差异有统计学意义（P<0.001）。观察组患者围手术期死亡率与对照组相近，差异无统 计学意义（P>0.05）。匹配人群中，观察组患者的手术时间、体外循环时间、主动脉阻断时间同样均长于对照组， 差异有统计学意义（P<0.001）。结论：行机器人辅助二尖瓣成形术患者的围手术期结局是安全、有效的，但是需要 进一步的长期随访资料评估远期有效性。

Objective: To compare the operative situations and perioperative outcomes between robot-assisted and conventional mitral valve repair using propensity score matching. Methods: A retrospective analysis was performed on 379 patients who underwent isolated mitral valve repair at Beijing Anzhen Hospital from June 2016 to December 2021. 122 patients who underwent robotic surgery were divided into the observation group, while 257 patients who underwent conventional median sternotomy were divided into the control group. Propensity score matching was used to choose 109 patients from each group, resulting in the creation of a matched population. The operation situations and perioperative outcomes in the overall population and the matched population were compared. Results: In the overall population, the operative time, cardiopulmonary bypass time, and aortic cross-clamp time were longer in the observation group than those in the control group, and the difference was not statistically significant (P<0.001). The perioperative mortality rate of the observation group was similar with the control group, and the difference was not statistically significant (P>0.05). In the matched population, the operative time, cardiopulmonary bypass time, and aortic cross-clamp time were also longer in the observation group than those in the control group (P<0.001). Conclusion: Robot-assisted mitral valve repair is safe and effective. However, further long-term follow-up data are required to evaluate its long-term efficacy

收稿日期：2024-01-25  录用日期：2024-03-18 

Received Date: 2024-01-25  Accepted Date: 2024-03-18 

基金项目：国家重点研发计划重点专项（2022YFA1205904） 

Foundation Item: Special Project of National Key R & D Plan (2022YFA1205904)  

通讯作者：尤斌，Email：dr_youbin@vip.sina.com 

Corresponding Author: YOU Bin, Email: dr_youbin@vip.sina.com 

引用格式：王寒初，尤斌，曲政 . 机器人二尖瓣成形术治疗原发性二尖瓣关闭不全的临床效果分析：倾向性评分匹配研究 [J]. 机器 人外科学杂志（中英文），2024，5（6）：1179-1185. 

Citation: WANG H C, YOU B, QU Z. Clinical efficacy of robot-assisted mitral valve repair for primary mitral regurgitation: a propensity score matching study[J]. Chinese Journal of Robotic Surgery, 2024,5(6)：1179-1185.

[1] 胡盛寿 , 王增武 . 《中国心血管健康与疾病报告 2022》概述 [J]. 中国心血管病研究 , 2023, 21(07): 577-600. 

[2] Lazam S, Vanoverschelde J L, Tribouilloy C, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: analysis of a large, prospective, multicenter, international registry[J]. Circulation, 2017, 135(5): 410-422. 

[3] Otto C M, Nishimura R A, Bonow R O, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the american college of cardiology/ american heart association joint committee on clinical practice guidelines[J]. Circulation, 2021, 143(5): e35-e71. 

[4] Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease[J]. Eur Heart J, 2022, 43(7): 561-632. 

[5] WEI S X, ZHANG X, CUI H M, et al. Comparison of clinical outcomes between robotic and thoracoscopic mitral valve repair[J]. Cardiovasc Diagn Ther, 2020, 10(5): 1167-1174. 

[6] Carpentier A, Loulmet D, Aupecle B, et al. Computer assisted open heart surgery. First case operated on with success[J]. C R Acad Sci III, 1998, 321(5): 437-442. 

[7] Mihaljevic T, Jarrett C M, Gillinov A M, et al. Robotic repair of posterior mitral valve prolapse versus conventional approaches: potential realized[J]. J Thorac Cardiovasc Surg, 2011, 141(1): 72-80. 

[8] 许李力 , 李平 , 徐屹 , 等 . 机器人心脏外科手术早期随访的安 全性及有效性研究 [J]. 机器人外科学杂志 ( 中英文 ), 2021, 2(6): 421-430. 

[9] Lange R, Voss B, Kehl V, et al. Right minithoracotomy versus full sternotomy for mitral valve repair: a propensity matched comparison[J]. Ann Thorac Surg, 2017, 103(2): 573-579. 

[10] Akowuah E F, Maier R H, Hancock H C, et al. Minithoracotomy vs Conventional Sternotomy for mitral valve repair: a randomized clinical trial[J]. JAMA, 2023, 329(22): 1957-1966. 

[11] 许李力 , 尤斌 , 高峰 , 等 . 直视微创与传统正中开胸主动脉瓣 置换术倾向性评分匹配对比研究 [J]. 疑难病杂志 , 2015, 14(1): 42-44. 

[12] 许世广 , 王述民 . 浅谈达芬奇机器人手术 500 例体会 [J]. 中国 胸心血管外科临床杂志 , 2015, 22(10): 895-900. 

[13] 李霞 , 马华怡 , 赖军华 , 等 . 心脏外科术后肺部并发症研究进展 [J]. 实用医学杂志 , 2023, 39(04): 510-513. 

[14] Mori M, Parsons N, Krane M, et al. Robotic mitral valve repair for degenerative mitral regurgitation[J]. Ann Thorac Surg, 2024, 117(1): 96-104. 

[15] Suri R M, Taggarse A, Burkhart H M, et al. Robotic mitral valve repair for simple and complex degenerative disease: midterm clinical and echocardiographic quality outcomes[J]. Circulation, 2015, 132(21): 1961-1968. 

[16] Aphram G, Melina G, Noirhomme P, et al. Robotic mitral valve repair-the Bruxelles experience[J]. Ann Cardiothorac Surg, 2022, 11(6): 589-595. 

[17] Arghami A, Jahanian S, Daly R C, et al. Robotic mitral valve repair: a decade of experience with echocardiographic follow-up[J]. Ann Thorac Surg, 2022, 114(5): 1587-1595. 

[18] Javadikasgari H, Suri R M, Mihaljevic T, et al. Technical aspects of robotic posterior mitral valve leaflet repair[J]. Ann Cardiothorac Surg, 2016, 5(6): 577-581.