Current state of the art and recommendations in robotic mitral valve surgery

Palmen, Meindert; Navarra, Emiliano; Bonatti, Johannes; Franke, Ulrich; Černý, Štěpán; Musumeci, Francesco; Modi, Paul; Singh, Sandeep; Sandoval, Elena; Pettinari, Matteo; Segers, Patrique; Gianoli, Monica; Praet, Frank Van; Praetere, Herbert De; Vojáček, Jan; Cebotaru, Theodor; Onan, Burak; Bolcal, Cengiz; Alhan, Cem; Ouda, Ahmed; Melly, Ludovic; Malapert, Ghislain; Labrousse, Louis; Agnino, Alfonso; Phillipsen, Tine; Jansens, Jean-Luc; Folliguet, Thierry; Suwalski, Piotr; Cathenis, Koen; Doguet, Fabien; Tomšič, Anton; Oosterlinck, Wouter; Pereda, Daniel

doi:10.1093/icvts/ivac160

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…Finally, to our knowledge, this is the first study showing an independent association between robotic-assisted MV surgery and a reduction in postoperative myocardial injury; this may be due to several factors. The association between robotic-assisted mitral valve surgery and shorter aortic cross-clamp time is controversial; apart from one study [ 23 ], most studies reported significantly longer times for robotic techniques [ 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. We deem that the independent association with less myocardial injury might be related to the more precise and less traumatic heart incisions and manipulation.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Higher Postoperative Myocardial Injury in Minimally Invasive Mitral Valve Surgery Patients: A Cohort Study

Baccanelli,

Albano,

Carrara

et al. 2024

JCM

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Background: Postoperative myocardial injury, as detected by an elevated concentration of high-sensitivity cardiac troponin I (hs-cTnI), is a common complication in cardiac surgery that may be linked to mortality. The primary aim of this study was to assess the risk factors associated with increased myocardial injury in patients undergoing minimally invasive mitral valve surgery. Methods: In this retrospective monocentric cohort study, we analyzed all patients who underwent elective minimally invasive mitral valve surgery between January 2019 and December 2022 and were subsequently admitted to our intensive care unit. The study population was divided into two groups based on the peak hs-cTnI level: the “lower myocardial injury” group comprised patients whose peak serum hs-cTnI level was less than 499 times the 99th percentile, while the “higher myocardial injury” group included those patients who exhibited hs-cTnI levels equal to or greater than 500 times the 99th percentile. A multivariable logistic regression analysis was performed to identify independent risk factors associated with higher myocardial injury. Results: In our final analysis, we enrolled 316 patients. Patients with higher myocardial injury (48; 15%) more frequently had a preoperative New York Heart Association (NYHA) class ≥3 compared to those with lower myocardial injury [33 (69%) vs. 128 (48%); p < 0.01—OR 2.41 (95% CI 1.24–4.64); p < 0.01]. Furthermore, cardiopulmonary bypass and aortic cross-clamp time were significantly longer in the higher myocardial injury group compared to the lower myocardial injury group [117 (91–145) vs. 86 (74–100) min; p < 0.01—OR 1.05 (95% CI 1.03–1.06); p < 0.01]. Moreover, patients who underwent robotic-assisted mitral valve surgery experienced lower myocardial injury rates [9 (19%) vs. 102 (38%); p = 0.01—OR 0.38 (95% CI 0.18–0.81); p = 0.01] than others. These findings remained consistent after adjustment in multivariate logistic regression. In terms of postoperative outcomes, patients with higher myocardial injury exhibited the highest lactate peak in the first 24 h, a higher incidence of postoperative acute kidney injury and a longer duration of mechanical ventilation. Although no patients died in either group, those with higher myocardial injury experienced a longer hospital length of stay. Conclusions: Higher myocardial injury is relatively common after minimally invasive mitral valve surgery. Prolonged aortic cross-clamp duration and higher NYHA class were independently associated with myocardial injury, while robotic-assisted mitral valve surgery was independently associated with lower postoperative myocardial injury.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Higher Postoperative Myocardial Injury in Minimally Invasive Mitral Valve Surgery Patients: A Cohort Study

Baccanelli,

Albano,

Carrara

et al. 2024

JCM

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“…Proper patient selection is crucial to secure safety and efficacy of robotic mitral valve repair surgery. It is recommended to perform an electrocardiogram-gated volumetric computed tomography angiography of the chest, abdomen and pelvis before surgery as an addition to the standard screening protocol ( 15 , 16 ). A recent report form the Cleveland Clinic demonstrated that a conservative screening algorithm will identify a contraindication for robotic intervention in approximately 40% of patients ( 15 ).…”

Section: Patient Selectionmentioning

confidence: 99%

Robotic mitral valve repair surgery: where do we go from here?

Tomšič

Palmen

2023

Front. Cardiovasc. Med.

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Surgical mitral valve repair through median sternotomy has long presented the treatment of choice for degenerative mitral valve disease. In recent decades, minimal invasive surgical techniques have been developed and are now gaining widespread popularity. Robotic cardiac surgery presents an emerging field, initially adopted only by selected centres, mostly in the United States. In recent years, the number of centers interested in robotic mitral valve surgery has grown with an increasing adoption in Europe as well. Increasing interest and surgical experience gained are stimulating further developments in the field and the full potential of robotic mitral valve surgery remains to be developed.

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“…Robotic cardiac surgery has increased and plateaued in the US where approximately 1,700 robotic mitral valve procedures per year were performed from 2009 to 2015 ( 12 ). In Europe, robotic cardiac surgery is becoming more widespread, with a steep increase in the annual number of cases as new centres take up this pioneering technology ( 13 , 14 ). However, recent changes in EU Medical Device Regulations affecting the Da Vinci robot are likely to temper this expansion until rectified.…”

Section: Introductionmentioning

confidence: 99%

Robotic mitral valve surgery

Massey,

Palmer,

Al-Rawi

et al. 2024

Front. Cardiovasc. Med.

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Totally endoscopic robotic mitral valve repair is the least invasive surgical therapy for mitral valve disease. Robotic mitral valve surgery demonstrates faster recovery with shorter hospital stays, less morbidity, and equivalent mortality and mid-term durability compared to sternotomy. In this review, we will explore the advantages and disadvantages of robotic mitral valve surgery and consider important technical details of both operative set-up and mitral valve repair techniques. The number of robotic cardiac surgical procedures being performed globally is expected to continue to rise as experience grows with robotic techniques and increasing numbers of cardiac surgeons become proficient with this innovative technology. This will be facilitated by the introduction of newer robotic systems and increasing patient demand.

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Current state of the art and recommendations in robotic mitral valve surgery

Cited by 11 publications

References 10 publications

Risk Factors for Higher Postoperative Myocardial Injury in Minimally Invasive Mitral Valve Surgery Patients: A Cohort Study

Risk Factors for Higher Postoperative Myocardial Injury in Minimally Invasive Mitral Valve Surgery Patients: A Cohort Study

Robotic mitral valve repair surgery: where do we go from here?

Robotic mitral valve surgery

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