Robotic Mitral Valve Repair for Simple and Complex Degenerative Disease

Background: Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci ® robotic system was performed in LatinAmerica. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil.Methods: From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery. Twenty-seven patients were male (69.2%), with the mean age of 51.3±17.9 years. Participants had a mean ejection fraction of 62±5%. The procedures included in this study were mitral valve surgery, surgical treatment of atrial fibrillation, atrial septal defect closure, resection of intra-cardiac tumors, totally endoscopic coronary artery bypass and pericardiectomy.Results: The mean time spent on cardiopulmonary bypass (CPB) during RCS was 154.9±94.2 minutes and the mean aortic cross-clamp time was 114.48±75.66 minutes. Thirty-two patients (82%) were extubated in the operating room immediately after surgery. The median intensive care unit (ICU) length of stay was 1 day (ranging from 0 to 25) and the median hospital length of stay was 5 days (ranging from 3 to 25). For each type of procedure, endpoints were individually reported. There were no conversions to sternotomy and no intra-operative complications. Patient follow-up was complete in 100% of the participants, with two early deaths unrelated to the procedures and no re-operations at mid-term.Conclusions: Despite the heterogeneity of this series, RCS appears to be feasible, safe and effective when used for the correction of various intra-and extra-cardiac pathologies. Adopting the robotic system has been a challenge in Brazil, where its limited clinical application may be related to the lack of specific training and the high cost of technology.

Section: Discussionmentioning

confidence: 78%

Robotic cardiac surgery in Brazil

Poffo

Toschi

Pope

et al. 2017

“…To maximize the patient's comfort, decrease the length of recovery and minimize pain management requirements, a minimally invasive approach should be used unless contraindicated. If feasible, robotically assisted mitral valve repair, the least invasive form of mitral valve surgery, should be considered for all patients with severe myxomatous MV disease (13)(14)(15).…”

Section: Patient Selection and Preoperative Work-upmentioning

confidence: 99%

Degenerative mitral valve disease-contemporary surgical approaches and repair techniques

Koprivanac

Kelava

Al-Ansari

et al. 2017

Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques.The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes.

“…A large number of single center series have confirmed the safety of robotic mitral valve surgery in experienced centers (1,2,(5)(6)(7)(8). Hospital mortality is generally less than 1% and the stroke rate is similarly low.…”

Section: Safety: Is Robotic Mitral Valve Surgery Safe?mentioning

confidence: 90%

Robotic mitral valve surgery: current limitations and future directions

Gillinov¹,

Suri²,

Mick³

et al. 2016

Use of the surgical robot facilitates less invasive mitral valve surgery. Although multiple single center studies confirmed excellent results with robotically-assisted mitral valve surgery, both real and perceived limitations have slowed adoption of this technology. Some still question the safety and efficacy of roboticallyassisted mitral valve surgery. However, present data suggests that robotic operations can be performed by specialized surgeons in appropriately selected patients without compromising results. That said, the robot does introduce additional procedural complexity related to management of cardiopulmonary bypass and myocardial protection. A direct approach to these challenges combined with careful patient selection enables the surgeon to obtain excellent results with robotically-assisted mitral valve surgery.