Benefits of robotically-assisted surgery for complex mitral valve repair

Abstract

OBJECTIVES To determine whether robotic mitral valve repair can be applied to more complex lesions compared with minimally invasive direct mitral valve repair through a right thoracotomy. METHODS We enrolled 335 patients over a 9-year period; 95% of the robotic surgeries were performed after experience performing direct mitral valve repair. RESULTS The mean age in the robotic versus thoracotomy repair groups was 61 ± 14 vs 55 ± 11 years, respectively (P < 0.001); 97% vs 100% of the patients, respectively, had degenerative aetiologies. Repair complexity was simple in 106 (63%) vs 140 (84%), complex in 34 (20%) vs 20 (12%) and most complex in 29 (17%) vs 6 (4%) patients undergoing robotic versus thoracotomy repair, respectively. The average complexity score with robotic repair was significantly higher versus thoracotomy repair (P < 0.001). The robotic group underwent more chordal replacement using polytetrafluoroethylene and less resections. All patients underwent ring annuloplasty. Cross-clamp time did not differ between the groups, and no strokes or deaths occurred. More patients undergoing robotic repair underwent concomitant procedures versus the thoracotomy group (30% vs 14%, respectively; P < 0.001). The overall repair rate was 100%, with no early mortality or strokes in either group. Postoperative mean residual mitral regurgitation was 0.3 in both groups, and the mean pressure gradient through the mitral valve was 2.4 vs 2.7 mmHg (robotic versus thoracotomy repair, respectively; P = 0.031). CONCLUSIONS Robotic surgery can be applied to repair more complex mitral lesions, with excellent early outcomes.

Follow-Up of Robotic Mitral Valve Repair: A Single Tertiary Institution Experience in China

“…Robotic surgery has been a major focus for cardiac surgeons. Robotic MVRep has been widely implemented in Europe and the United States as well as in Asian countries [ 12 – 17 ]. This study reported the clinical data and follow-up results of 120 Chinese patients receiving robotic mitral valve surgery.…”

Minimally invasive and robotic approaches to mitral valve: Robotic is best

“…The same authors also analyzed their entire robotic mitral experience over the same period in which 24% (of 500) was considered most complex (bileaflet repair or atrioventricular groove reconstruction for mitral annular calcification) and concluded that despite longer crossclamp time and cardiopulmonary bypass time, the patient outcomes have not worsened despite having more complex repairs. 11 Similarly, Fujita and colleagues 12 presented 9-year data on 335 patients undergoing either robotic or a minithoracotomy approach; 17% and 4% of the repairs, respectively, were considered most complex and the robotic approach was associated with excellent early outcomes.…”

Minimally invasive mitral valve surgery with or without robotics: Examining the evidence

“…29,30 Some centers have assessed the feasibility of robotic-assisted MIMVS in a wide range of mitral pathologies with more complex repair techniques (e.g., bileaflet repair, mitral annular calcification excision). [31][32][33] Fujita et al reported that patients who underwent robotic-assisted MIMVS had a higher complexity score requiring more complex repairs than patients undergoing minithoracotomy MIMVS. 32 Neo-chord implantation was attempted more in robotic-assisted MIMVS though procedure times did not differ between the two groups.…”

“…[31][32][33] Fujita et al reported that patients who underwent robotic-assisted MIMVS had a higher complexity score requiring more complex repairs than patients undergoing minithoracotomy MIMVS. 32 Neo-chord implantation was attempted more in robotic-assisted MIMVS though procedure times did not differ between the two groups. Regarding complexity, Rowe et al…”