Is robotic mitral valve repair a reproducible approach?

Cheng, Wen; Fontana, Gregory P.; De Robertis, Michele A.; Mirocha, James; Czer, Lawrence S.C.; Kass, Robert M.; Trento, Alfredo

doi:10.1016/j.jtcvs.2009.10.047

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 3 , Pages 628-633, March 2010

Is robotic mitral valve repair a reproducible approach?

Read at the Thirty-fifth Annual Meeting of The Western Thoracic Surgical Association, Banff, Alberta, Canada, June 24–27, 2009.

Division of Cardiothoracic Surgery, Cedars–Sinai Medical Center, Los Angeles, Calif

Received 23 June 2009; received in revised form 14 October 2009; accepted 25 October 2009. published online 28 December 2009.

Objective

We sought to review the surgical outcomes of our initial 120 robotic mitral valve repairs from June 2005 through April 2009.

Methods

The initial 74 repairs were performed with the first-generation da Vinci robot (Intuitive Surgical, Inc, Sunny Vale, Calif), and the last 46 were performed with the da Vinci Si HD model. All patients received an annuloplasty band and 1 or more of the following: leaflet resection; annuloplasty; basal chord transposition, polytetrafluoroethylene neochordal replacement, or both; and edge-to-edge repair.

Results

The overall mean age was 58.4 ± 10.5 years, and 64% were male. There was 1 (0.8%) hospital mortality. Five patients required mitral valve replacement for a failed repair. Another patient had mitral valve rerepair on postoperative day 2. Except for 2 early reoperations for postoperative bleeding, all of the complications and failed repairs requiring operative revision occurred with the original robot. Postdischarge transthoracic echocardiographic follow-up was available on 107 (93%) of 115 patients, with a median follow-up of 321 days. None to mild mitral regurgitation was seen in 102 (89%) patients, moderate mitral regurgitation was seen in 9 (8.4%) patients, and severe mitral regurgitation was seen in 3 (2.8%), with 1 patient undergoing mitral valve replacement and 2 patients being medically managed.

Conclusions

The majority of complications and all the repeat operations for failed mitral valve repair occurred with the older-model da Vinci robot. The newer da Vinci Si HD system, with the addition of an adjustable left atrial roof retractor, improves mitral valve exposure, enhancing the surgeon's ability to repair and test the valve. We have progressed to successful repair of all types of degenerative mitral valve pathology and have found the approach reproducible.

CTSNet classification: 35, 35.4, 35.4.1

Abbreviations and Acronyms: MR, mitral regurgitation, SAM, systolic anterior motion, TEE, transesophageal echocardiography