Multicenter Mitral Valve Study: A Lateral Approach Using the da Vinci Surgical System

Objective The purpose of this study was to demonstrate the feasibility of simple to complex endoscopic robotic mitral valve repair, using a lateral approach. Methods Data were retrospectively collected on 201 patients undergoing a lateral “ports only” endoscopic robotic mitral valve repair at three institutions. Techniques of aortic occlusion included the endoaortic balloon or a transthoracic clamp. The efficacy of the repair was measured intraoperatively by transesophageal echocardiogram. Results Two hundred one patients with a mean age of 55.2 ± 14.2 were intended to undergo elective robotic mitral valve surgery. One hundred eighty-six (92.5%) were scheduled for a repair procedure and 15 (7.5%) were scheduled for replacement. The repair was accomplished in 179 of 186 (96.2%) of patients. Eight patients (4.3%) required a conversion to sternotomy incision. Seven converted patients received a mitral valve repair and one received a replacement mitral valve. Mitral valve pathology included 10% isolated anterior leaflet involvement, 43% isolated posterior leaflet involvement, and 6% bileaflet pathology, and the remaining patients had dilated annulus, chordal rupture, or elongation. One hundred seventy-nine patients (96.2%) had regurgitation grade of 0 to 1 after repair. Two patients (1%) died. Other adverse events included reoperation for valve-related complications, 2 of 201 (1%); reoperation for cardiac-related complications, 3 of 201 (1.5%); and new onset of atrial fibrillation, 35 of 201 (17.4%). Conclusions A lateral endoscopic robotic approach to mitral valve repair is safe, feasible, and can be performed consistently with acceptable postoperative results. Further follow-up is required to determine the long-term efficacy of this approach to robotic mitral valve repair.

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Mitral valverepair: types of correction, immediateand long-term results

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2008-14-1-91-96 ◽

2008 ◽

Vol 14 (1) ◽

pp. 91-96

Author(s):

N. Shikhverdiev ◽

G. Khubulava ◽

S. Marchenko ◽

M. Askerov

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Surgical Correction ◽

Long Term Results ◽

Valve Repair ◽

Reconstructive Procedures ◽

Valve Pathology

The types of surgical correction of the mitral valve pathology, hospital and long-term results were studied. The mitral valve repair being compared to the mitral valve replacement is procedure of choice as it provides stable results. In the study we demonstrate that the long-term results of reconstructive procedures on the mitral valve have advantages over mitral valve replacement in terms of survival, freedom from reoperation and tromboembolc complications.

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Robotic mitral valve repair: Trapezoidal resection and prosthetic annuloplasty with the da Vinci Surgical System

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2000.110177 ◽

2000 ◽

Vol 120 (6) ◽

pp. 1171-1172 ◽

Cited By ~ 112

Author(s):

W.Randolph Chitwood ◽

L.Wiley Nifong ◽

Joseph E. Elbeery ◽

William H. Chapman ◽

Robert Albrecht ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Da Vinci ◽

Da Vinci Surgical System ◽

Valve Repair ◽

Vinci Surgical System ◽

Surgical System

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Abstract 16046: Conventional versus Right Mini-thoracotomy versus Robotic Mitral Valve Replacement/repair; Insights From a Network Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.16046 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yujiro Yokoyama ◽

Hisato Takagi ◽

Toshiki Kuno

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Meta Analysis ◽

Mitral Valve Surgery ◽

Valve Repair ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Mini Thoracotomy

Background: Benefits and risks of minimally invasive cardiac surgery (MICS) through right mini-thoracotomy and robotic surgery for mitral valve are not fully understood. We conducted a network meta-analysis comparing the perioperative and long-term outcomes of mitral valve surgery via conventional sternotomy, MICS and robot. Methods: MEDLINE and EMBASE were searched through March 15th, 2020 to identify randomized controlled trials (RCTs) and propensity-score matched (PSM) trials that investigated perioperative and long-term outcomes after mitral surgery via conventional sternotomy, MICS and robot. Subanalyses were conducted by restricting trials, in which mitral valve repair was tried first for all patients. Results: Our systematic literature search identified 2 RCTs and 21 PSM trials. MICS was related to significant decrease in PM ([RR] [95% confidence interval [CI] =0.56 [0.40-0.78]] and SSI (RR [95%CI] =0.53 [0.33-0.85) compared to conventional sternatomy. Re-exploration for bleeding was significantly higher in robot compared to sternotomy (RR [95% CI] =1.56 [1.03-2.37]), and transfusion was higher in sternotomy compared to MICS (RR [95%CI] =1.63 [1.27-2.08]). No significant differences were observed in perioperative mortality, MI, stroke, and LCOS among there procedures. Similarly, there were no significant differences in long-term survival and mitral valve reoperation. Suanalyses by restricting trials in which mitral valve repair tried first for all patients showed MICS was related to significant increase in mitral valve reoperation compared to conventional sternotomy (hazard ratio [95%CI] =7.33 [1.54-34.97]) (Figure). Conclusion: Our network meta-analysis demonstrated similar long-term survival and mitral valve reoperation. However, MICS was related to significant increase in mitral valve reoperation after mitral valve repair compared to conventional sternotomy.

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Increasing Mitral Valve Repair Rates with Nonresectional Techniques

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182181b4b ◽

2011 ◽

Vol 6 (4) ◽

pp. 209-220 ◽

Cited By ~ 9

Author(s):

J. Scott Rankin ◽

Jeffrey G Gaca ◽

Louis A. Brunsting ◽

Mani A. Daneshmand ◽

Carmelo A. Milano ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Long Term Results ◽

Valve Repair ◽

Multiple Sources ◽

Technical Application ◽

Mitral Repair ◽

Mitral Disease

In every common mitral pathology studied to date, repairing the patient's own diseased valve to adequate function has yielded superior long-term results as compared with prosthetic valve replacement with either tissue or mechanical devices. Thus, increasing rates of mitral repair across all valve pathologies would seem to be a logical clinical goal. Techniques for mitral valve repair have undergone continual evolution over the past 50 years. Recently, emphasis has been placed on preserving leaflet surface area and avoiding tissue resection, by combining the methods of Gore-Tex artificial chordal replacement, autologous pericardial leaflet augmentation, and full ring annuloplasty. Using combinations of these three techniques appropriate to the given valve pathology, acute mitral repair rates now are approximating 98% for all common mitral disease etiologies. Simultaneously, operative mortalities for mitral repair have fallen significantly and now are negligible, whereas long-term outcomes using these methods have been increasingly more stable. As a result of innovations from multiple sources, mitral valve surgery has been converted from a higher risk procedure to one of the safest operations in most centers. This review will detail the technical application of “nonresectional” mitral repair approaches to a broad range of mitral disease pathologies.

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Long-Term Outcomes Comparing Minimally Invasive Mitral Valve Repair versus Conventional Mitral Valve Surgery

World Journal of Cardiovascular Surgery ◽

10.4236/wjcs.2018.88012 ◽

2018 ◽

Vol 08 (08) ◽

pp. 127-139

Author(s):

Matthew Jackson ◽

Manraj S. Sandhu ◽

Chao Dong ◽

Bilal Bawamia ◽

Muhammad Qureshi ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Repair ◽

Long Term Outcomes

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Standardized Strategy and Long-Term Surgical Outcome of Mitral Valve Repair in Congenital Mitral Stenosis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0035-1544529 ◽

2015 ◽

Vol 63 (S 01) ◽

Author(s):

E. Delmo Walter ◽

A. Amiri ◽

R. Hetzer

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Surgical Outcome ◽

Mitral Stenosis ◽

Valve Repair ◽

Congenital Mitral Stenosis

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Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519841292 ◽

2019 ◽

Vol 14 (3) ◽

pp. 281-285 ◽

Cited By ~ 1

Author(s):

Burak Onan ◽

Ersin Kadirogullari ◽

Zeynep Kahraman ◽

Onur Sen

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Da Vinci Surgical System ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Valve Repair ◽

Septal Myectomy ◽

Mitral Repair

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

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