Robotic-assisted mitral valve surgery without aortic cross-clamping: a safe and feasible technique

Abstract

BackgroundThe primary objective of this study was to evaluate the safety and feasibility of robotic-assisted mitral valve surgery without aortic cross-clamping.MethodsFrom January 2010 to September 2022, 28 patients underwent robotic-assisted mitral valve surgery without aortic cross-clamping in our center using DaVinci Robotic Systems. Clinical data during the perioperative period and early outcomes of the patients were recorded.ResultsMost patients were in New York Heart Association (NYHA) class II and III. Mean age and EuroScore II of the patients were 71.5 ± 13.5 and 8.4 ± 3.7 respectively. The patients underwent either mitral valve replacement (n = 16, 57.1%) or mitral valve repair (n = 12, 42.9%). Concomitant procedures were performed including tricuspid valve repair, tricuspid valve replacement, PFO closure, left atrial appendage ligation, left atrial appendage thrombectomy and cryoablation for atrial fibrillation. Mean CPB times were 140.9 ± 44.6 and mean fibrillatory arrest duration was 76.6 ± 18.4. Mean duration of ICU stay was 32.5 ± 28.8 h and mean duration of hospital stay 9.8 ± 8.3 days. One patient (3.6%) underwent revision due to bleeding. New onset renal failure was observed in one (3.6%) patient and postoperative stroke in one (3.6%) patient. Postoperative early mortality was observed in two (7.1%) patients.ConclusionsRobotic-assisted mitral valve surgery without cross-clamping is a safe and feasible technique in high-risk patients undergoing redo mitral surgery with severe adhesions as well as in primary mitral valve cases that are complicated with ascending aortic calcification.

Is There a Future for Minimal Access and Robots in Cardiac Surgery?

“…A prime example is the presence of mitral valve regurgitation or stenosis in patients who have previously undergone aortic valve surgery or coronary artery bypass grafting. If the aortic valve is competent, the procedure may be performed via thoracotomy on the beating and/or fibrillating heart, without the need to dissect fragile bypass grafts or divide severe adhesions from previous sternotomies [ 53 , 54 ] (given the required surgical experience is present [ 21 ]). Considering that such approaches may allow the establishment of a mechanical result that has the currently best potential for long-term durability, these options are valuable, since the currently available interventional alternatives appear to have not demonstrated their long-term potential and the initial results are questionable [ 55 ].…”