A conservative screening algorithm to determine candidacy for robotic mitral valve surgery

Robotic mitral valve surgery after prior sternotomy

“… 3 , 4 , 5 , 6 , 7 At some centers, there has also been a growing experience with robotic-assisted minimally invasive approaches in patients undergoing mitral valve surgery. 8 , 9 , 10 , 11 However, prior sternotomy has been considered a relative contraindication to robotic mitral valve surgery for reasons related to adhesions and lack of experience with robotic techniques. Despite these concerns, the robotic technique has been applied to reoperative mitral valve surgery in a small number of cases, but the safety of this approach has not been closely examined.…”

Commentary: Robotic mitral valve surgery selection criteria: Screening algorithm or quantifying selection bias?

“…Chemtob and colleagues 1 assess the Cleveland Clinic screening algorithm for robotic surgery in patients with isolated degenerative mitral valve disease. They report that 60% of patients who were evaluated in the study met their criteria for a robotic approach.…”

Commentary: Surgical treatment of atrial fibrillation at the time of cardiac surgery: Just do it

“…There were no mortalities in the robotic or sternotomy groups, and the rates of stroke were similar (0.5% for robotic and 1.0% for sternotomy). 2 We do find that many patients are referred to our center specifically for robotic mitral valve surgery, and many are Robotic mitral valve repair has advantages like excellent visualization and agile instrumentation. However, minimally invasive surgery is only appropriate when it does not sacrifice safety or quality.…”

“…We have adopted a conservative screening algorithm, which we use to counsel patients about the most appropriate, data-driven approach for each patient’s anatomy and physiology. 2 Patients with greater-than-mild aortic regurgitation, left ventricular dysfunction, or pulmonary hypertension are offered open surgery to optimize myocardial protection through antegrade and retrograde cardioplegia. Patients with more-than-minimal mitral annular calcification are offered open surgery in the event that extensive debridement and reconstruction of the atrioventricular grove is required.…”

“…There were no mortalities in the robotic or sternotomy groups, and the rates of stroke were similar (0.5% for robotic and 1.0% for sternotomy). 2 …”