Robotic Mitral Valve Repair for Degenerative Mitral Valve Regurgitation

Lazar, Harold L.

doi:10.1161/circulationaha.115.019843

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…In sharp contrast to urologic and obstetric surgery, the logistic, financial, and other constraints of the current generation of robotic technology have limited this approach. 15 The Minneapolis Heart Institutet (MHI) Approach At MHI, our structural heart surgical team has had training and experience in sternotomy, hemisternotomy, and port access techniques. In general, the port version of the right mini-thoracotomy approach is currently preferred over the lower hemisternotomy secondary to the optimal valve visualization.…”

Section: The Minimally Invasive Eramentioning

confidence: 99%

What's New in Mitral Valve Repair?

DiBardino

Farivar

2017

Journal of the Minneapolis Heart Institute Foundation

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Mitral valve repair is the standard of care for degenerative mitral valve pathology, as established by the median sternotomy approach. Equivalently excellent results can be achieved by a variety of more minimally invasive approaches depending on institutional experience and preferences. At the Minneapolis Heart Institutet, we have experience with and utilize all approaches to mitral valve repair for degenerative disease including full and hemisternotomy, right thoracotomy, mini-thoracotomy and heart port approaches. We believe that logistic, economic, and anticipated benefit constraints currently limit the application and the robotic technology. Leaflet maneuvers continue to be important in mitral valve repair, but recently we have revisited the concept of simplifying a ''complex'' repair in the setting of a subset of severe degenerative (Barlow's) disease by utilizing only an oversized mitral valve ring with excellent results. As suggested by others, in the appropriate setting of bileaflet prolapse resulting in central symmetric regurgitation, a simplified approach may be just as effective as longer, more complicated operations. 1. Degenerative MV disease can be repaired in the majority of cases with a durable long-term result and very low reoperative rate. Experienced centers can reproducibly expect repair rates of over 90% with a 1% failure rate/year. 2. The life expectancy curves for those that undergo repair approach those of the normal life expectancy curves for men and women, and in certain cases may be better than twins without the disease. 3. The repair techniques include a finite list of leaflet maneuvers and should always include the placement of a ring for annular fixation. The leaflet maneuvers include various resections, plications, commissure, and cleft closures; edge-toedge repairs; and artificial chord placement based upon the findings of the echo and the appearance of the degenerative pathology at the time of surgery. KEY WORDSGiven the evolution and success of these surgical tenets, the American College of Cardiology/American Heart Association guidelines have recommended MV surgery for symptomatic MR and minimally symptomatic MR in the presence of left ventricular dilation or dysfunction, and-at centers of excellence-can be considered for asymptomatic patients. Secondary to these recommendations, an estimated 40,000 MV operations take place in the US per year; given the low prevalence of rheumatic disease in the US, the majority of these patients are sent to surgery with MR and the majority of them are potential candidates for MV repair rather than replacement.

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Section: The Minimally Invasive Eramentioning

confidence: 99%

What's New in Mitral Valve Repair?

DiBardino

Farivar

2017

Journal of the Minneapolis Heart Institute Foundation

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“…1 MV repair has become the procedure of choice in such patients because of its documented advantages over valve replacement regarding long-term survival, freedom from valve-related adverse events and preservation of left ventricular function. [2][3][4][5][6][7][8] Furthermore, lifelong anticoagulation therapy and the associated increased risk of hemorrhage are generally avoided with MV repair. 9 MV repair is feasible in more than 95% of patients and restores normal or near-normal valve function.…”

Section: Introductionmentioning

confidence: 99%

“…Degenerative mitral valve (MV) disease is the most common indication for surgical referral to treat mitral regurgitation . MV repair has become the procedure of choice in such patients because of its documented advantages over valve replacement regarding long‐term survival, freedom from valve‐related adverse events and preservation of left ventricular function . Furthermore, lifelong anticoagulation therapy and the associated increased risk of hemorrhage are generally avoided with MV repair .…”

Section: Introductionmentioning

confidence: 99%

Choosing the “Best” surgical techniques for mitral valve repair: Lessons from the literature

et al. 2019

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Mitral valve (MV) repair is the procedure of choice to correct mitral regurgitation caused by degenerative MV disease, due to its well‐documented superiority over MV replacement. Repair of the MV is feasible in more than 95% of such patients and restores valve function and preserve ventricular function. Surgeons choose from a wide variety of mitral repair techniques, with the ultimate procedure based upon the pathology and the particular surgeon's personal preference. As a result, there is considerable controversy concerning choice of repair techniques and prostheses (ie, annuloplasty device). This targeted review of available data concerning repair of the degenerative valve will inform surgeon decision‐making in MV repair.

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