An analysis of the learning curve for robotic‐assisted mitral valve repair

Abstract

Background: Many cardiac surgeons receive training for sternotomy-based cardiac surgical operations in residency programs and only a few education programs offer training specifically in minimally invasive cardiac surgery. In this report, we aimed to search and analyze the learning curve for robotic-assisted mitral valve (MV) repair in cardiac surgeons. Method: Between January 2010 and July 2019, 60 robotic-assisted isolated MV repair surgeries were performed with DaVinci Robotic Systems in our center. Different kinds of surgical techniques were used. The assessment of the learning curve was based on cardiopulmonary bypass (CPB) and transthoracic aortic clamp (CC) times. Result: There were 23 (38.3%) men and 37 (61.7%) women with a mean age of 48.3 years. The lesions of the MV were posterior leaflet prolapsus (n = 42, 70.0%), anterior leaflet prolapsus (n = 8, 13.3%), Barlow disease (n = 3, 5%), and annular dilatation (n = 7, 11.6%). The patients underwent notochordal implantation (n = 27, 45%), quadrangular or triangular resection (n = 23, 38.3%), isolated ring annuloplasty (n = 7, 11.7%), resection, and leaflet reduction (n = 2, 3.3%) or edge to edge repair (n = 1, 1.7%). The maturation of the learning curve appeared to be about 30 cases. The statistical analysis showed that the mean CPB and CC times for the first 30 cases were greater compared with the 30 after learning curve (155.3 vs. 118.9 min [p = .00], 102.3 vs. 80 min [p = .00], respectively). There was no case of conversion to open surgery. No perioperative mortality was observed. Conclusion: The maturation of the learning curve for robotic-assisted MV repair appeared to be about 30 cases in our group of patients. This study had encouraging results for surgeons who desire to start a robotic mitral surgery program.

Building a successful minimally invasive mitral valve repair program before introducing the robotic approach: The Massachusetts General Hospital experience

“…However, robotic deployment, in addition to the difficulties inherent to a new procedure, is even more limited by its cost and low availability of equipment. Nevertheless, the learning curves appear to be acceptable, with reported rapid reductions in cross-clamp times and stabilization after 20–30 cases ( 28 , 29 ). As mentioned above, facilitation of papillary muscle and mitral valve exposure and free multi-dimensional movement of surgical instruments are advantages of robotic MV surgery compared to the established methods.…”

Robotically assisted mitral valve repair—port-only totally endoscopic approach

“…Despite these benefits, there appears to be a learning curve early in the implementation of a robotic program as measured by longer cardiopulmonary bypass (CPB) and aortic cross-clamp times (6). As such, case volume is essential for success of teMVR to successfully navigate the learning curve (7). Here we describe the approach to teMVR, an evolving option for the management of degenerative mitral valve disease and mitral regurgitation (Video 1).…”

The technical details of robotic-assisted mitral valve replacement

“…The adoption of robotic technique is more slowly in cardiac surgery comparing to other specialities for many reasons, including cost, the need for dedicated anesthesiologists, nurses, perfusionists, and more importantly, lack of proper training of whole team (5). In a recently published study, we analyzed the learning curve for mitral valve repair, which may be applicable to replacement procedures as well (6). In that study, we analyzed and compared the CPB and CC times as the measurement tools for the learning curve and had encouraging results for the surgeons who desire to start a robotic mitral surgery program.…”