Robotic Posterior Mitral Leaflet Repair: Neochordal Versus Resectional Techniques

Mihaljević, Tomislav; Pattakos, Gregory; Gillinov, A. Marc; Bajwa, Gurjyot; Planinc, Mislav; Williams, Sarah; Blackstone, Eugene H.

doi:10.1016/j.athoracsur.2012.08.042

Cited by 46 publications

(26 citation statements)

References 15 publications

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“…30,31 Repair success seems to be excellent, with a rate of residual mitral regurgitation greater than trace reported to be 2.3-2.8%. 28,29 According to published data, perioperative mortality is 0-1%. [28][29][30] Minimally invasive techniques for posterior leaflet mitral valve repair were compared with the sternotomy approach in a propensity score-matched comparison.…”

Section: Mitral Valve Repairmentioning

confidence: 98%

“…28,29 According to published data, perioperative mortality is 0-1%. [28][29][30] Minimally invasive techniques for posterior leaflet mitral valve repair were compared with the sternotomy approach in a propensity score-matched comparison. 31 For the robotic technique, median cardiopulmonary bypass time was 42 min longer than with sternotomy, 39 min longer than with partial sternotomy, and 11 min longer than with anterolateral minithoracotomy.…”

Section: Mitral Valve Repairmentioning

confidence: 98%

“…28,29 Robotically assisted mitral valve repair can be performed with a very low rate (3.0-4.3%) of conversion to larger incisions. 30,31 Repair success seems to be excellent, with a rate of residual mitral regurgitation greater than trace reported to be 2.3-2.8%.…”

Section: Mitral Valve Repairmentioning

confidence: 99%

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Robotic technology in cardiovascular medicine

et al. 2014

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Robotic technology has been used in cardiovascular medicine since the late 1990s. Interventional cardiology, electrophysiology, endovascular surgery, minimally invasive cardiac surgery, and laparoscopic vascular surgery are all fields of application. Robotic devices enable endoscopic reconstructive surgery in narrow spaces and fast, very precise placement of catheters and devices in catheter-based interventions. In all robotic systems, the operator manipulates the robotic arms from a control station or console. In the field of cardiac surgery, mitral valve repair, CABG surgery, atrial septal defect repair, and myxoma resection can be achieved using robotic technology. Furthermore, vascular surgeons can perform a variety of robotically assisted operations to treat aortic, visceral, and peripheral artery disease. In electrophysiology, ablation procedures for atrial fibrillation can be carried out with robotic support. In the past few years, robotically assisted percutaneous coronary intervention and abdominal aortic endovascular surgery techniques have been developed. The basic feasibility and safety of robotic approaches in cardiovascular medicine has been demonstrated, but learning curves and the high costs associated with this technology have limited its widespread use. Nonetheless, increased procedural speed, accuracy, and reduced exposure to radiation and contrast agent in robotically assisted catheter-based interventions, as well as reduced surgical trauma and shortened patient recovery times after robotic cardiovascular surgery are promising achievements in the field.

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Section: Mitral Valve Repairmentioning

confidence: 98%

Section: Mitral Valve Repairmentioning

confidence: 98%

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Robotic technology in cardiovascular medicine

et al. 2014

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“…In the past, they have based their concerns on inferior economics, safety, and outcomes. To date, the results of major RMVP series and meta-analyses parallel those of sternotomy operations done by experienced repair surgeons (30)(31)(32)(33)(34)(35)(36)(37). Recently, Paul and colleagues reviewed data from 50,408 patients having had any mitral repair in the United States between 2008 and 2012 (35).…”

Section: Conclusion and Perspectivementioning

confidence: 99%

“…Nevertheless, recent large series have proven the benefits to both patients and surgeons, and that this technology is ideal for performing mitral surgery (29)(30)(31)(32)(33)(34)(35)(36)(37). Part of the continued success relates to the evolution of the daVinci System and custom instruments.…”

mentioning

confidence: 99%

Robotic mitral valve surgery: overview, methodology, results, and perspective

Chitwood¹

2016

Ann. Cardiothorac. Surg.

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Robotic mitral valve repair began in 1998 and has advanced remarkably. It arose from an interest in reducing patient trauma by operating through smaller incisions with videoscopic assistance. In the United States, following two clinical trials, the FDA approved the daVinci Surgical System in 2002 for intra-cardiac surgery. This device has undergone three iterations, eventuating in the current daVinci XI. At present it is the only robotic device approved for mitral valve surgery. Many larger centers have adopted its use as part of their routine mitral valve repair armamentarium. Although these operations have longer perfusion and arrest times, complications have been either similar or less than other traditional methods. Preoperative screening is paramount and leads to optimal patient selection and outcomes. There are clear contraindications, both relative and absolute, that must be considered. Three-dimensional (3D) echocardiographic studies optimally guide surgeons in operative planning. Herein, we describe the selection criteria as well as our operative management during a robotic mitral valve repair. Major complications are detailed with tips to avoid their occurrence. Operative outcomes from the author's series as well as those from the largest experiences in the United States are described. They show that robotic mitral valve repair is safe and effective, as well as economically reasonable due to lower costs of hospitalization. Thus, the future of this operative technique is bright for centers adopting the "heart team" approach, adequate clinical volume and a dedicated and experienced mitral repair surgeon. Keynote Lecture SeriesHe who is fixed to a star does not change his mind.--Leonardo da Vinci Evolutionary overviewWith the development and improvement of endoscopic vision in the late 1970s, the notion of laparoscopic operations was spawned and then developed rapidly, despite early reservations by most surgeons. This skepticism was gradually overcome as many traditional general surgical, gynecological and urological operations were replaced rapidly by less invasive and/or endoscopic operations. During this era, cardiac surgery had evolved so well using sternotomy incisions that there seemed to be no incentive for cardiac surgeons to adopt either secondary vision or less invasive incisions. Non-cardiac thoracic surgeons were the first to embrace this disruptive methodology and they proved that major pulmonary operations could be done safely and effectively using thoracoscopic techniques. The idea of minimally invasive cardiac surgery emanated from the "Heartport Era" with the development of new innovative aortic occlusive devices, long-shafted instruments and ports for cardiac access (1,2). These developments issued the clarion call that minimally invasive cardiac surgery was possible and that surgeons must begin

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