Minimally Invasive and Robotic Mitral Valve Surgery: Methods and Outcomes in a 20-Year Review

Bonatti, Johannes; Crailsheim, Ingo; Grabenwöger, Martin; Winkler, Bernhard

doi:10.1177/15569845211012389

Cited by 20 publications

(19 citation statements)

References 64 publications

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“…Patients can obviously benefit from totally endoscopic robotic-assisted approaches given maintenance of thoracic cage integrity, and should have better functional recovery. The procedural safety can be improved upon by training, practice and standardized protocols ( 18 , 19 ). An experienced team setup is important.…”

Section: Discussionmentioning

confidence: 99%

Robotic mitral valve repair in National Taiwan University Hospital: 10-year results

Chou¹,

Wang²,

Huang³

et al. 2022

Ann Cardiothorac Surg

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Background: With the help of robotic surgical systems and their 3-dimensional, high-resolution imaging, mitral repair with long shaft instruments and endo-wrist functionality has become a feasible reality. Patients benefit from maintained thoracic cage integrity, reduced surgical trauma, and faster return to normal functional activity. We describe National Taiwan University Hospital's 10-year experience with roboticassisted mitral valve repair procedures for repairing mitral regurgitation.Methods: We performed a retrospective observational cohort study of patients undergoing robotic-assisted mitral valve repair for severe mitral regurgitation at National Taiwan University Hospital. Between January 2012 and September 2022, 450 consecutive patients underwent robotic mitral valve repair with or without additional cardiac procedures. All procedures were completed by a single surgical team.Results: Four hundred and fifty patients, with 272 (60.4%) isolated mitral repairs and 178 (39.6%) combined additional (one or more) cardiac procedures were performed. The Euroscore II estimate mortality was 3.1%±2.7%. The average cardiopulmonary bypass (CPB) time was 124±42 minutes, and the average operation time was 165±51 minutes. Perioperative and 30-day mortality was observed in one (0.22%) patient.Mean intensive care unit stay was 26.5±26.0 hours. Postoperative stroke was observed in one (0.22%) patient and new-onset atrial fibrillation was observed in 71 (15.78%) patients. All patients were in less than mild mitral regurgitation and 422 (93.78%) had none or trace regurgitation at discharge. Freedom from moderate mitral regurgitation was 97.6%, and freedom from mitral valve reoperation was 98% at 10 years.Conclusions: With standardized robotic procedures and non-compromised repair techniques, excellent short-term outcomes and long-term valve repair durability can be achieved in experienced centers.

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Section: Discussionmentioning

confidence: 99%

Robotic mitral valve repair in National Taiwan University Hospital: 10-year results

Chou¹,

Wang²,

Huang³

et al. 2022

Ann Cardiothorac Surg

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“…Furthermore, the surgical procedure is simplified with a shorter procedural time and would likely be advantageous in minimally invasive procedures, in cases of challenging anatomy, in combined procedures, or in any cases where reduced CPB and aortic cross-clamping time are particularly advisable. [24][25][26][27][28] The crucial time in conventional chordae implantation is the anchoring procedure to the papillary muscle and correct length measurements. These 2 procedures are actually done prior to the ischemic time and cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an Innovative Device for Mitral Valve Regurgitation: Experimental Acute In Vivo Results

Zeitani

Chiariello

Shofti

et al. 2022

Innovations�(Phila)

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Objective Currently, mitral prosthetic rings are intended only to reshape the annulus. We present in vivo results of an innovative device characterized by an intraventricular segment designed to enable artificial chordae implantation and simplify leaflets and subvalvular apparatus correction. Methods: Eight sheep were employed. The first 4 underwent solely device implantation. In the last 4, primary chordae of the anterior leaflet (A2) were torn to induce severe mitral regurgitation. The severed chordae were replaced by 2 pairs of 5-0 Gore-Tex artificial chordae previously measured and anchored to the device bridge. Ease of device and chordae implantation were evaluated, and postprocedural valve competence was verified by postoperative echocardiogram. Results: The procedure was completed in all 8 sheep. In the 4 sheep with induced severe mitral regurgitation, repair could be achieved by means of artificial chordae implantation. Length of the 2 chordae implanted was 21.6 ± 2 mm and 22 ± 3 mm, respectively. The time required to suture the artificial chordae was 2.5 ± 1.2 min. Postoperative echocardiograms showed normal left ventricular ejection fraction and free motion of the mitral leaflets. Mitral regurgitation was absent in 5 cases and trivial in 3. The transvalvular peak pressure gradient was 9.5 ± 6 mm Hg, and mean gradient was 3.7 ± 4 mm Hg. Postprocedural evaluation of the heart and mitral valve showed no damage to the left ventricle wall, valve leaflets, chordae, and papillary muscles. Conclusions: In vivo tests confirm safety of the device, ease of chordal length estimation prior to implantation, short operative time, and no negative impact of the device on mitral leaflet motion, function, and structure.

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“…A quarter of mitral valve surgeries is performed with minimally invasive techniques every year (1) and the adoption of robotic-assisted approaches has become increasingly popular due to the advantages related to smaller surgical incisions (i.e., less postoperative pain, better cosmetic result, shorter length of hospital stay, and more rapid return to a better level of functional activity) (2,3). In this frame, the positive role of mitral valve repair for the Two hundred robotic mitral valve repair procedures for degenerative mitral regurgitation: the Yale experience surgical treatment of degenerative mitral regurgitation has been extensively validated in the literature, with a strong correlation between surgeon-level volume and clinical outcomes (4).…”

Section: Introductionmentioning

confidence: 99%

Two hundred robotic mitral valve repair procedures for degenerative mitral regurgitation: the Yale experience

Amabile¹,

Morrison²,

LaLonde³

et al. 2022

Ann Cardiothorac Surg

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Background: Robotic surgery has gained popularity over the past two decades due to the benefits related to smaller surgical incisions, enhanced technical dexterity and better intraoperative visualization. We present the Yale experience of the first two hundred totally endoscopic, robotic-assisted mitral valve repair procedures for the treatment of degenerative mitral regurgitation.Methods: We performed a retrospective cohort study of patients undergoing totally endoscopic, roboticassisted isolated or concomitant mitral valve repair for degenerative mitral regurgitation at Yale-New Haven Hospital from October 2018 to April 2022. Mitral valve repair procedures for rheumatic or secondary functional mitral regurgitation and planned robotic-assisted mitral valve replacement cases were excluded.Results: Two hundred consecutive procedures were performed. The median age was 65 years (interquartile range, 58-73 years). Six patients (3.0%) had a history of mediastinal radiation, four patients (2.0%) had previous cardiac surgery, and one patient (0.5%) had cardiac dextroversion. Median cardiopulmonary bypass and aortic cross-clamp times were 122 and 79 minutes, respectively. Femoral vessel cannulation was performed percutaneously in 57 (28.5%) patients with no major access-site related complication. Aortic cross-clamping was performed with the endoaortic balloon occlusion device in 151 (75.5%) patients. No conversions to sternotomy occurred. Satisfactory repair was achieved in 100% of cases, with 184 (92.0%) and 16 (8.0%) of patients having trace/none or mild residual mitral regurgitation, respectively. Forty-two patients (21.0%) underwent concomitant Cox-maze procedure and 25 patients (12.5%) underwent concomitant tricuspid valve repair. Thirty-day mortality rate was 0.5%, with an observed-to-expected ratio of 0.53. Two patients (1.0%) underwent re-exploration for bleeding, one had early postoperative stroke (0.5%), five developed pneumothorax (2.5%) and two required dialysis for acute renal failure (1.0%). The median length of hospital stay was four days.Conclusions: Excellent short-term outcomes can be achieved in experienced centers for the treatment of degenerative mitral regurgitation with a totally endoscopic, robotic-assisted approach.

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Minimally Invasive and Robotic Mitral Valve Surgery: Methods and Outcomes in a 20-Year Review

Cited by 20 publications

References 64 publications

Robotic mitral valve repair in National Taiwan University Hospital: 10-year results

Robotic mitral valve repair in National Taiwan University Hospital: 10-year results

Evaluation of an Innovative Device for Mitral Valve Regurgitation: Experimental Acute In Vivo Results

Two hundred robotic mitral valve repair procedures for degenerative mitral regurgitation: the Yale experience

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