Robot-assisted mitral valve repair: A single institution review

Castigliano Bhamidipati, Gaurav S. Mehta, Muhammad F. Sarwar, Renganaden Sooppan, Karikehalli A. Dilip, Charles J. Lutz

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Objective: Mitral valve repair (MVR) is the definitive therapy for mitral myxomatous degeneration. Median sternotomy has been the traditional approach to repair until the advent of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA). Minimally invasive surgical approaches for mitral repair have been slow to gain acceptance in cardiac surgery. We review the MVR results from our single-institution academic robotic program. Methods: From August 2004 through April 2008, patients who underwent a robotic-assisted (RA) MVR were identified. RA technique included a 4-cm right minithoracotomy, femoral cardiopulmonary bypass with transthoracic aortic occlusion, and RA-MVR. Repair types were combinations of quadrangular/triangular leaflet resection, sliding plasty, chordal transfer/replacement, and edge-to-edge approximation, with band annuloplasty in all cases. Postrepair echocardiography and morbidity follow-ups were completed in all patients. Our primary outcome was adequacy of repair, and secondary outcome was major complications. Results: There were 43 patients (29 male and 14 female) who underwent RA-MVR for severe (4+) mitral regurgitation during the 4-year review. Average operative time was 272.26 minutes. Only one patient had mild postoperative mitral regurgitation, whereas 20 had trace and 22 had no regurgitation after repair. Mean ventilator time was 32.1 hours, and length of stay was 5.7 days. One third of the patients (33%) received postoperative-packed red blood cell transfusions (average: 2.4 units per patient). Twenty-eight percent of patients developed atrial fibrillation after repair. Most of the patients (95.3%) were discharged home. There were no 30-day mortalities. Conclusions: Based on our small single-institution experience, RA-MVR provides an effective treatment for severe mitral valve regurgitation. Although procedure durability is slowly being established, preliminary results are promising. Careful programmatic advances with an integrated team approach can facilitate acceptable postoperative outcomes and excellent MVR.

Original languageEnglish (US)
Pages (from-to)295-299
Number of pages5
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume5
Issue number4
DOIs
StatePublished - Jul 1 2010
Externally publishedYes

Fingerprint

Mitral Valve
Robotics
Mitral Valve Insufficiency
Erythrocyte Transfusion
Sternotomy
Mechanical Ventilators
Operative Time
Thigh
Cardiopulmonary Bypass
Atrial Fibrillation
Thoracic Surgery
Echocardiography
Length of Stay
Morbidity
Mortality
Therapeutics

Keywords

  • Case-series
  • Mitral valve repair
  • Robot-assisted

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Robot-assisted mitral valve repair : A single institution review. / Bhamidipati, Castigliano; Mehta, Gaurav S.; Sarwar, Muhammad F.; Sooppan, Renganaden; Dilip, Karikehalli A.; Lutz, Charles J.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 5, No. 4, 01.07.2010, p. 295-299.

Research output: Contribution to journalReview article

Bhamidipati, Castigliano ; Mehta, Gaurav S. ; Sarwar, Muhammad F. ; Sooppan, Renganaden ; Dilip, Karikehalli A. ; Lutz, Charles J. / Robot-assisted mitral valve repair : A single institution review. In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2010 ; Vol. 5, No. 4. pp. 295-299.
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AU - Mehta, Gaurav S.

AU - Sarwar, Muhammad F.

AU - Sooppan, Renganaden

AU - Dilip, Karikehalli A.

AU - Lutz, Charles J.

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N2 - Objective: Mitral valve repair (MVR) is the definitive therapy for mitral myxomatous degeneration. Median sternotomy has been the traditional approach to repair until the advent of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA). Minimally invasive surgical approaches for mitral repair have been slow to gain acceptance in cardiac surgery. We review the MVR results from our single-institution academic robotic program. Methods: From August 2004 through April 2008, patients who underwent a robotic-assisted (RA) MVR were identified. RA technique included a 4-cm right minithoracotomy, femoral cardiopulmonary bypass with transthoracic aortic occlusion, and RA-MVR. Repair types were combinations of quadrangular/triangular leaflet resection, sliding plasty, chordal transfer/replacement, and edge-to-edge approximation, with band annuloplasty in all cases. Postrepair echocardiography and morbidity follow-ups were completed in all patients. Our primary outcome was adequacy of repair, and secondary outcome was major complications. Results: There were 43 patients (29 male and 14 female) who underwent RA-MVR for severe (4+) mitral regurgitation during the 4-year review. Average operative time was 272.26 minutes. Only one patient had mild postoperative mitral regurgitation, whereas 20 had trace and 22 had no regurgitation after repair. Mean ventilator time was 32.1 hours, and length of stay was 5.7 days. One third of the patients (33%) received postoperative-packed red blood cell transfusions (average: 2.4 units per patient). Twenty-eight percent of patients developed atrial fibrillation after repair. Most of the patients (95.3%) were discharged home. There were no 30-day mortalities. Conclusions: Based on our small single-institution experience, RA-MVR provides an effective treatment for severe mitral valve regurgitation. Although procedure durability is slowly being established, preliminary results are promising. Careful programmatic advances with an integrated team approach can facilitate acceptable postoperative outcomes and excellent MVR.

AB - Objective: Mitral valve repair (MVR) is the definitive therapy for mitral myxomatous degeneration. Median sternotomy has been the traditional approach to repair until the advent of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA). Minimally invasive surgical approaches for mitral repair have been slow to gain acceptance in cardiac surgery. We review the MVR results from our single-institution academic robotic program. Methods: From August 2004 through April 2008, patients who underwent a robotic-assisted (RA) MVR were identified. RA technique included a 4-cm right minithoracotomy, femoral cardiopulmonary bypass with transthoracic aortic occlusion, and RA-MVR. Repair types were combinations of quadrangular/triangular leaflet resection, sliding plasty, chordal transfer/replacement, and edge-to-edge approximation, with band annuloplasty in all cases. Postrepair echocardiography and morbidity follow-ups were completed in all patients. Our primary outcome was adequacy of repair, and secondary outcome was major complications. Results: There were 43 patients (29 male and 14 female) who underwent RA-MVR for severe (4+) mitral regurgitation during the 4-year review. Average operative time was 272.26 minutes. Only one patient had mild postoperative mitral regurgitation, whereas 20 had trace and 22 had no regurgitation after repair. Mean ventilator time was 32.1 hours, and length of stay was 5.7 days. One third of the patients (33%) received postoperative-packed red blood cell transfusions (average: 2.4 units per patient). Twenty-eight percent of patients developed atrial fibrillation after repair. Most of the patients (95.3%) were discharged home. There were no 30-day mortalities. Conclusions: Based on our small single-institution experience, RA-MVR provides an effective treatment for severe mitral valve regurgitation. Although procedure durability is slowly being established, preliminary results are promising. Careful programmatic advances with an integrated team approach can facilitate acceptable postoperative outcomes and excellent MVR.

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