Minimally Invasive Redo Mitral Valve Replacement using a Robotic-Assisted Approach

Clinical Outcomes of Mitral Valve Reoperations in the United States: An Analysis of The Society of Thoracic Surgeons National Database

“…For surgeons who are adept at right chest approaches to MVS, the theoretical benefit of alternative approaches to reoperative MVS are in avoiding adhesions that would be encountered during re-sternotomy. Reoperative MVS through right minithoracotomy or thoracotomy with or without the use of a robot have been described previously [7,12] A single institutional series of 173 reoperative MVSs performed by right thoracotomy demonstrated an operative mortality rate of 4.1%, with a stroke rate of 6% and new-onset dialysis rate of 2.3% [7] The potentially increased risk of stroke with retrograde perfusion during peripheral cannulation, as is frequently done in minimally invasive approaches, has been debated. Although our study did not evaluate stroke rates between approaches, a reappraisal using contemporary STS national registry data is perhaps prudent.…”

Mitral Valve Surgery via a Right Infra-axillary Thoracotomy in High-Risk Reoperative Patients

“…In the past, redo mitral valve operations were usually performed through median sternotomy, with high risk and mortality. With further development of surgical techniques, minimally invasive redo mitral valve surgery has become reliable, with results comparable to those of conventional techniques [Casselman 2007, Bolotin 2004, Patel 2017]. Therefore, there is great interest in less invasive and safer approaches to heart surgery, especially when these alternative access routes decrease surgical risk and do not compromise quality.…”

“…Second, this incision offers excellent visualization of mitral valve structures in a direct-line view. Moreover, it is easy to learn and practice compared with other minimally invasive approaches, thoracoscopy, or robotic technology [Bolotin 2004, Patel 2017, Cao 2017, Holzhey 2013. It is mostly similar to the median sternotomy.…”

“…The entire procedure is performed under direct vision without additional devices, such as video-assisted thoracoscopic equipment. The incision may be one of the most economical and practical procedures compared with other minimally invasive approaches, the thoracoscopy [Bolotin 2004], and robotic technology [Patel 2017]. Onnasch [2002] described redo mitral valve surgery by right thoracotomy, which is a good alternative, but it requires special instrumentation such as the Chitwood/Cosgrove clamp, a knotter/pusher, and occasionally thoracoscopic assistance.…”

“…Although operative mortality might not be considered with intraoperative injury in some studies [Ellman 2008, Ghoreishi 2013, most studies showed that overall mortality was significantly higher if reentry injury occurred [Park 2010, Roselli 2008. Therefore, several strategies have been described as safe alternatives to the conventional redo sternotomy, including the right anterolateral thoracotomy approach [Onnasch 2002], thoracoscopy [Bolotin 2004], the roboticassisted approach [Patel 2017], and transcatheter mitral valve implantation [Keenan 2019]. Durations of the operation and hospitalization can be used as a benchmark.…”