Robotic Mitral Valve Surgey Combined with Left Atrial Reduction and Ablation Procedures

Abstract

Introduction This study aimed to evaluate the feasibility and efficacy of robotically assisted, minimally invasive mitral valve surgery combined with left atrial reduction for mitral valve surgery and elimination of atrial fibrillation (AF). Methods Eleven patients with severe mitral regurgitation, AF, and left atrial enlargement who underwent robotic, minimally invasive surgery between May 2013 and March 2018 were evaluated retrospectively. The da Vinci robotic system was used in all procedures. The patients’ demographic data, electrocardiography (ECG) findings, and pre- and postoperative transthoracic echocardiography findings were analyzed. During follow up ECG was performed at postoperative 3, 6, and 12 months additionally at the 3 rd month trans thoracic echocardiography was performed and functional capacity was also evaluated for all patients. Results All patients underwent robotic-assisted mitral valve surgery with radiofrequency ablation and left atrial reduction. Mean age was 45.76±16.61 years; 7 patients were male and 4 were female. Preoperatively, mean left atrial volume index (LAVI) was 69.55±4.87 mL/m 2 , ejection fraction (EF) was 54.62±8.27%, and pulmonary artery pressure (PAP) was 45.75±9.42 mmHg. Postoperatively, in hospital evaluation LAVI decreased to 48.01±4.91 mL/m 2 ( P =0.008), EF to 50.63±10.13% ( P >0.05), and PAP to 39.02±3.11 mmHg ( P =0.012). AF was eliminated in 8 (72%) of the 11 patients at the 1 st postoperative month. There were significant improvements in functional capacity and no mortality during follow-up. Conclusion Left atrial reduction and radiofrequency ablation concomitant with robotically assisted minimally invasive mitral valve surgery can be performed safely and effectively to eliminate AF and prevent recurrence.

Robotic‐assisted cardiac surgery without lung isolation utilizing single‐lumen endotracheal tube intubation

“…The patients were placed in the supine position with the right chest elevated and external defibrillation pads were placed 4‐6 . The right internal jugular vein, the right femoral artery and vein were cannulated for CPB.…”

“…Robotically‐assisted cardiac surgery has been increasingly used approach to treat a variety of complex cardiac pathologies in adults 1‐11 . With innovative techniques, robotics is added value in heart surgery and complementary to catheter‐based interventions 27 .…”

“…Robotic‐assisted cardiac surgery has become a commonly used minimally invasive approach for mitral valve disease and atrial septal defects over the last two decades 1‐11 . Totally endoscopic robotic atrial septal defect (ASD) repair remains a highly complex procedure, which requires experience with several nonroutine operative steps, such as airway management and set‐up.…”

“…Nevertheless, right‐sided unilateral pulmonary edema developed in several patients. With the goal of providing better outcomes, the studies and alternative techniques in minimally invasive cardiac surgery were reviewed 1‐26 . The literature on robotic cardiac surgery presented no recommendations about the use of SL endotracheal tubes without lung isolation.…”

“…During these procedures, minithoracotomy was performed first, then the lungs were deflated after CPB initiation and operations were done. Similarly, we applied this technique in robotic cardiac procedures using SL endotracheal intubation without lung isolation 4‐9 . We hypothesized that difficulties of intubation, procedural times, and potential complications might be reduced using traditional SL intubation, rather than more complex techniques of lung isolation.…”