Commentary: Safety first!

Abstract

Central MessageTo perform increasingly complex MV surgery using robotic access technology, a careful and considerate approach to patient selection is paramount to ensure successful outcomes.“Luck runs out, but safety is good for life.”—UnknownSee Article page 46. To perform increasingly complex MV surgery using robotic access technology, a careful and considerate approach to patient selection is paramount to ensure successful outcomes. See Article page 46. In this interesting paper by Meidan and colleagues1Meidan T. Lanfear A. Squiers J. Hamandi M. Lytle B. DiMaio J. et al.Robotic mitral valve surgery after prior sternotomy.J Thorac Cardiovasc Surg Tech. 2022; 13: 46-51Scopus (1) Google Scholar from the great state of Texas, we are given an excellent single-center review of 21 patients who underwent robotic mitral valve (MV) surgery after previous sternotomy over a 7-year period. The authors acknowledge that for many burgeoning robotic MV programs, previous sternotomy is a strong relative contraindication to a robotic approach due to intrathoracic adhesions, aberrant anatomy, and an overall lack of experience with robotic techniques. However, the authors also assert that as robotic cardiac surgeons acquire increased technical experience and gain expertise as well as confidence, the robotic access platform is adaptable to more challenging cases. In this experience, the robotic platform was used for reoperative MV surgery in 21 patients who were older (median age 71 years), with a Society of Thoracic Surgeons predicted risk of mortality of 4.2 ± 3.8%. The indications for MV surgery included degenerative disease, functional disease, and failed repair for degenerative disease. Outcomes were excellent, with no conversions to open surgery, no intraoperative deaths, no 30-day mortalities, no strokes or wound infections, and 1-year mortality of 4.8%. This experience could be elucidated further by a discussion of the selection and exclusion criteria for which patients with previous sternotomy should be considered candidates for robotic surgery. Over the study period, 342 patients underwent MV surgery after previous sternotomy, although a robotic access platform was used in only 21 patients (6.1%). In addition to understanding what specifically made these patients appropriate for a robotic approach, it would be helpful to know what characteristics excluded patients from the possibility of robotic surgery. As we forge boldly ahead into the third decade of robotic intracardiac surgery with greater surgeon comfort performing challenging cases on the robotic platform, careful patient selection will be critical for successful outcomes. Robotic mitral valve surgery after prior sternotomyJTCVS TechniquesVol. 13PreviewDespite the recent increase in the use of minimally invasive approaches to mitral valve surgery in patients with a prior sternotomy, the outcomes of the robotic approach to mitral valve surgery in this patient population have not been examined. Full-Text PDF Open Access