Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

Abstract

OBJECTIVESRobotic mitral valve replacement (MVR) emerged in the late 1990s as an alternative approach to conventional sternotomy. With the increased use of bioprosthetic valves worldwide and strong patient desire for minimally invasive procedures, the safety and feasibility of robotic MVRs with bioprosthetic valves require investigation.METHODSBetween January 2013 and May 2017, 52 consecutive patients underwent robotic MVRs using the da Vinci Si surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Their mean age was 55.1 ± 13.8 years, and mean EuroSCORE II was 2.25% ± 1.25%. Among the enrolled patients, 32 (61.5%) patients presented with preoperative atrial fibrillation, 6 (11.5%) patients had experienced embolic stroke and 5 (9.6%) patients had undergone previous cardiac surgery. The operations were performed using cardiopulmonary bypass (CPB) under an arrested heart status.RESULTSFive porcine valves and 47 bovine valves were implanted. A total of 38 (73.1%) patients received concomitant cardiac procedures, including 26 Cox-maze IV procedures, 12 tricuspid valve repairs and 5 atrial septal defect repairs. The mean aortic cross-clamp and CPB times were 141.3 ± 34.3 min and 217.1 ± 42.0 min, respectively. There was no operative mortality. During the mean follow-up of 29 ± 15 months, no prosthesis degeneration was noted. The average left atrial dimension exhibited a significant decrease from 51.4 ± 11.5 mm to 42.6 ± 10.1 mm.CONCLUSIONSRobotic MVR with bioprosthetic valves is safe, feasible and reproducible. Mid-term results are encouraging. Both aortic cross-clamp and CPB times can be improved with experience.

Comparison of the Surgical Effect and the Long-term Clinical Outcomes Between Robotic and Sternotomy Mitral Valve Replacement

“…Compared with CS-MVR, the CPB and ACC times of TE-MVR were signi cantly longer than CS-MVR, which was reported previously [12,13] and the process of operative time shortening was similar to the learning curve reported in Kuo's study [14]. However, shorter CPB and ACC durations were seen in our study than in Kuo's report (122.02±25.45 min vs. 217.1 ± 42.0 and 85.68±20.70 min vs. 141.3 ± 34.3min), mainly because of rapid development of a robotic surgical regimen by intense practice of concurrent multiple varieties of robotic cardiac procedures with a xed specialist team.…”

“…Mitral valve repair is quite tricky for severe rheumatic valvular pathology [22] and MVR is inevitable among these rheumatic patients. Moreover, the majority of patients opted for a mechanical valve rather than a bioprosthetic valve [14]. But surgeons and patients in developed countries are more willing to choose biological valves.…”

Robotic Cardiac Surgery in Europe: Status 2020

“…The major challenge is dealing with calcification and valve suture arrangement with the robotic arms in place. The largest series was reported by Kuo et al ( 17 ) from Tainan and Taipeh in Taiwan, including 52 patients who received bioprosthetic replacements with 73% concomitant procedures such as maze procedures, patent foramen ovale closure, and TV repair. The conversion rate to sternotomy was 1.9 and 1.9% of the patients were re-explored for bleeding.…”

Comparison of postoperative outcomes between robotic mitral valve replacement and conventional mitral valve replacement

“…Senay et al 19 performed r‐MVR on 18 rheumatic mitral valve patients and according to their results, r‐MVR for a severe rheumatic mitral disease is technically feasible. In the study of Kuo et al, 20 a total of 52 patients with rheumatic and generative mitral valve disease underwent r‐MVR with bioprosthetic valve; they determined r‐MVR with bioprosthetic valves is safe, feasible, and reproducible. In the literature review, there were no publications other than these studies on r‐MVR, and our study constitutes the largest series in terms of replacement.…”