The accuracy of wearable, optically based HR monitors varies with exercise type and is greatest on the treadmill and lowest on elliptical trainer. Electrode-containing chest monitors should be used when accurate HR measurement is imperative.

Robotic mitral valve surgery is associated with a high likelihood of valve repair and low operative mortality and morbidity. The combination of algorithm-driven patient selection and increased experience enhanced clinical outcomes and procedural efficiency.

Robot-assisted mitral valve (MV) repair was introduced in the late 1990s with the goal of improving the technical precision of less-invasive surgical MV reconstruction. The broad advantages of robotic MV repair include an excellent 3-dimensional view of the valve pathology and better maneuverability of the endoscopic instruments (Figure 1). In this review, we sought to (1) delineate the timing and patient selection criteria for robotic MV repair, (2) review important technical criteria, and (3) describe the early postoperative and midterm outcome advantages of this technology.

Recognizing the well-documented clinical benefits of CR, ACC/AHA and European guidelines strongly recommend CR after myocardial infarction and coronary revascularization and structured exercise in patients with heart failure (6,7). Despite the clinical benefits of CR, only 20% to 30% of eligible patients complete a CR program (3,6-8). The requirement that patients travel to a CR center has been cited as a barrier to CR (9). To address this challenge, centers have developed in-home CR programs and "telerehabilitation" programs, the latter employing electronic communication and/or remote monitoring as

Robotic and minimally invasive mitral valve (MV) procedures have been performed with increasing frequency over time. These alternatives offer similar efficacy to that achieved via standard median sternotomy, particularly in large volume centers, along with low perioperative morbidity and mortality rates. Moreover, patient acceptance is oftentimes increased due to less postoperative pain and shorter recovery times, as well as superior cosmetic results. However, these techniques are technically complex and associated with a significant learning curve. The following review offers an overview of the most relevant aspects related to minimally invasive and robotic MV repair. Although these techniques are well established in referral centers, future innovations should concentrate on decreasing complexity and improving reproducibility of these procedures.

Early surgical intervention has become more common in patients with degenerative MV disease, regardless of valve prolapse complexity or symptom status. Valve repair was associated with similarly low operative risk and time-related survival but less durability in complex disease. Lifelong annual echocardiographic surveillance after MV repair is recommended, particularly in patients with complex disease.

Using the automated fastener to facilitate annuloplasty fixation through a sternotomy resulted in a small procedural time savings (average of 10 s/stitch) that had no overall impact on cardiopulmonary bypass or cross-clamp times but added an average cost of $1,026 to the operation.

Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority.