Robotic mitral valve repairs in 300 patients: A single-center experience

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: 99%

“…Robotic mitral valve repair or replacement was performed using a technique previously described by Chitwood et al (8).…”

Section: Mitral Valve Operationsmentioning

confidence: 99%

Robotic cardiac surgery in Brazil

Poffo

Toschi

Pope

et al. 2017

“…The practice of robot-assisted mitral valve repair (MVR) offers numerous potential benefits to patients including shorter hospital length of stay (1)(2)(3), reduced postoperative pain (4), a lower rate of surgical site infection (4), diminished incidence of blood product transfusion (5,6), a faster return to normal daily activities (5,7), and greater overall patient satisfaction (4). Anesthesiologists play in a key role in facilitating optimal outcomes after robotic MVR.…”

Section: Perspectivementioning

confidence: 99%

Anesthetic considerations in robotic mitral valve surgery

Rehfeldt

Andre

Ritter

2017

The robotic approach to cardiac surgery offers patients numerous potential advantages compared with a traditional sternotomy approach including shorter hospital length of stay, reduced pain, fewer blood transfusions, and a quicker return to normal daily activities. At the same time, robotic cardiac surgery requires that the anesthesiologist employs several subspecialty skillsets in order to provide optimal care for these patients. Multiple different regional anesthesia techniques may be used to improve analgesia, reduce opioid dosages, and facilitate rapid extubation at the conclusion of the case. Several peripheral cannulation strategies for cardiopulmonary bypass (CPB) exist and the anesthesia team may assist with percutaneous cannulation of the superior vena cava (SVC) or positioning of an endo-pulmonary vent. Similarly the anesthesiologist may be asked to percutaneously cannulate the coronary sinus for retrograde cardioplegia delivery. The need for one-lung ventilation (OLV) and heavy reliance on transesophageal echocardiography (TEE) occupy much of the anesthesiologist's attention during these cases. Variations in institutional practice exist. Reviews of current practice and future studies may help refine the anesthetic approach to robot-assisted cardiac surgery.

“…Robotic mitral valve surgery has been demonstrated as a safe and effective approach for selected patients in specialized centres (1)(2)(3). Mitral valve repair for patients with myxomatous disease has been successfully performed through standardized robotic techniques with excellent clinical outcomes (4).…”

Section: Perspectivementioning

confidence: 99%

Robotic surgery is the optimal approach for mitral surgery

Cao

Clark

Suri

2016

This report presented an overview of the patient selection, technical considerations and clinical evidence for robotic mitral valve surgery. A review of comparative outcomes to medical therapy, sternotomy approach, and the MitraClip device suggested that robotic mitral valve surgery is safe and effective in specialized centres.Potential benefits include a reliable and durable repair, with reduced perioperative morbidity and improved quality of life. Future studies should aim to delineate mid-and long-term clinical and echocardiographic outcomes following robotic mitral valve repair compared to the conventional sternotomy approach.