The Expanding Role of Endoscopic Robotics in Mitral Valve Surgery: 1,257 Consecutive Procedures

Results: Successful MV repair was achieved in 98.4% (n=305) of patients, with no significant residual mitral regurgitation (MR) postoperatively. There were no early postoperative deaths. Early postoperative complications included: stroke (n=3, 1.0%), new onset dialysis (n=1, 0.3%) and reoperation (n=3, 1.0%).During a median follow-up of 55.7 months (inter-quartile range 30.3 to 81.3 months), six (1.9%) patients died, while four patients underwent late reoperation for mitral regurgitation (n=2) or infective endocarditis (n=2). Major event-free survival at five years was 87.6%. Late echocardiographic profiles (>6 months)were obtained in 295 (95.2%) patients. During follow-up, 32 (10.8%) patients developed significant mitral regurgitation (MR > grade 2), while freedom from significant MR at five years was 86.5%. Conclusions:Robotic MV repair is a safe procedure with acceptable postoperative results, including low early postoperative morbidity and mortality and acceptable long-term repair durability.

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of robotic mitral valve repair: a single-center experience in Korea

Kim

Jung

et al. 2017

“…A large number of single center series have confirmed the safety of robotic mitral valve surgery in experienced centers (1,2,(5)(6)(7)(8). Hospital mortality is generally less than 1% and the stroke rate is similarly low.…”

Section: Safety: Is Robotic Mitral Valve Surgery Safe?mentioning

confidence: 85%

Robotic mitral valve surgery: current limitations and future directions

Gillinov¹,

Suri²,

Mick³

et al. 2016

Use of the surgical robot facilitates less invasive mitral valve surgery. Although multiple single center studies confirmed excellent results with robotically-assisted mitral valve surgery, both real and perceived limitations have slowed adoption of this technology. Some still question the safety and efficacy of roboticallyassisted mitral valve surgery. However, present data suggests that robotic operations can be performed by specialized surgeons in appropriately selected patients without compromising results. That said, the robot does introduce additional procedural complexity related to management of cardiopulmonary bypass and myocardial protection. A direct approach to these challenges combined with careful patient selection enables the surgeon to obtain excellent results with robotically-assisted mitral valve surgery.

“…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

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