Minimally invasive mitral valve repair using the da Vinci robotic system.

BACKGROUND Minimally invasive mitral valve repair with a shortened hospital stay and quick return to an active lifestyle is the ultimate goal for robotically assisted surgery. We evaluated our da Vinci robotically assisted mitral valve repair experience toward achieving this goal. METHODS All procedures were performed with peripheral cardiopulmonary bypass, transthoracic aortic cross-clamp, and antegrade cardioplegia. Two ports and a 4-cm intercostal incision in the right chest were used for access. All patients had a ring annuloplasty, and all but 1 had a posterior leaflet resection. The entire repair and all knot tying were performed robotically. RESULTS Between October 2001 and October 2002, 25 patients (18 men) underwent robotic mitral valve repair. The mean age was 56 years (range, 37 to 81 years). There were no incisional conversions, deaths, strokes, or reoperations for bleeding. Twenty-one (84%) of 25 patients were extubated in the operating room. Overall mean study times were as follows: procedure, 199.7 minutes (range, 140 to 287 minutes); cardiopulmonary bypass, 126.6 minutes (range, 89 to 186 minutes); and cross-clamp, 87.7 minutes (range, 58 to 143 minutes). Eight (32%) patients were discharged home in less than 24 hours, with an average length of stay of 2.7 days. Comparing the first 10 patients to the last 15 there was a significant reduction of times: total operating room time, 318.5 versus 275.1 minutes; cross-clamp, 97.6 versus 81.1 minutes; leaflet resection or repair, 26.2 versus 15.6 minutes; annuloplasty ring, 31.9 versus 24.8 minutes; and length of stay, from 4.2 days to 1.67 days. Five patients had postoperative atrial fibrillation. Two (8%) patients ultimately required mitral valve replacement for recurrent mitral insufficiency. CONCLUSIONS Mitral valve repair can be successfully performed with the da Vinci robotic system. Long-term follow-up is needed to determine the durability of the repair compared with a standard sternotomy approach.

[1]  D. Hayes.  Evolution of mitral valve surgery. , 1958, A.M.A. archives of internal medicine.

[2]  W. Chitwood,et al.  Evolution of mitral valve surgery: toward a totally endoscopic approach. , 2001, The Annals of thoracic surgery.

[3]  F. Casselman,et al.  Endoscopic mitral valve repair: feasible, reproducible, and durable. , 2003, The Journal of thoracic and cardiovascular surgery.

[4]  C Detter,et al.  Three-dimensional video and robot-assisted port-access mitral valve operation. , 2000, The Annals of thoracic surgery.

[5]  W. Chitwood,et al.  Robotic mitral valve repair: experience with the da Vinci system. , 2003, The Annals of thoracic surgery.

[6]  W. Chitwood,et al.  Minimally Invasive Videloscopic Mitral Valve Surgery: The Current Role of Surgical Robotics , 2000, Journal of cardiac surgery.

[7]  L. Cohn,et al.  Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. , 1997, Annals of surgery.

[8]  M. Enriquez-Sarano,et al.  Very Long-Term Survival and Durability of Mitral Valve Repair for Mitral Valve Prolapse , 2001, Circulation.

[9]  W. Chitwood,et al.  Minimally invasive mitral valve repair using transthoracic aortic occlusion. , 1997, The Annals of thoracic surgery.

[10]  A. Berrebi,et al.  Less invasive techniques for mitral valve surgery. , 1998, The Journal of thoracic and cardiovascular surgery.

[11]  F. Mohr,et al.  Control of endoaortic clamp position during Port-Access mitral valve operations using transcranial Doppler echography. , 1998, The Annals of thoracic surgery.

[12]  D. Cosgrove,et al.  Minimally invasive valve operations. , 1998, The Annals of thoracic surgery.

[13]  F. Mohr,et al.  The evolution of minimally invasive mitral valve surgery 2 year experience 1 Presented at the 12th , 1999 .