Invited Commentary

Abstract

Lewis and colleagues [1Lewis C.T.P. Stephens R.L. Tyndal C.M. Cline J.L. Concomitant robotic mitral and tricuspid valve repair: technique and early experience.Ann Thorac Surg. 2014; 97: 782-788Google Scholar] present a unique series of 50 consecutive patients undergoing combined mitral and tricuspid valve operation using robotic assistance. Series of tricuspid valve operations are unusual in general, and this may be the largest and most significant series using robotics.Several points can be made from these data. First, although robotic procedures tend to have longer procedure times relative to sternotomy, these authors were able to obtain very reasonable operating times and excellent results over a 5-year experience in a community hospital setting. Second, they were able to master a difficult procedure with a significant learning curve (and make significant improvements over time) by using a consistent, small, and dedicated team to maximize and focus the team members' experience. Third, success was also associated with careful patient selection, namely, patients with functional mitral and tricuspid regurgitation amenable to simple repairs that can be performed quickly with the robot.The ultimate role of robotics in mitral/tricuspid surgery will await additional experience in other centers and careful comparison with alternative approaches such as conventional sternotomy and thoracotomy without robotics. Yet, this paper demonstrates a successful model for applying a very new technology to a difficult group of patients in a hospital setting not traditionally associated with scientific advancement. Although any surgeon, group, or hospital may apply new technology such as robotic mitral and tricuspid repair to any patient they choose, successful outcomes may require the focus, judgment, and persistence over time seen in this report for ultimate success. Lewis and colleagues [1Lewis C.T.P. Stephens R.L. Tyndal C.M. Cline J.L. Concomitant robotic mitral and tricuspid valve repair: technique and early experience.Ann Thorac Surg. 2014; 97: 782-788Google Scholar] present a unique series of 50 consecutive patients undergoing combined mitral and tricuspid valve operation using robotic assistance. Series of tricuspid valve operations are unusual in general, and this may be the largest and most significant series using robotics. Several points can be made from these data. First, although robotic procedures tend to have longer procedure times relative to sternotomy, these authors were able to obtain very reasonable operating times and excellent results over a 5-year experience in a community hospital setting. Second, they were able to master a difficult procedure with a significant learning curve (and make significant improvements over time) by using a consistent, small, and dedicated team to maximize and focus the team members' experience. Third, success was also associated with careful patient selection, namely, patients with functional mitral and tricuspid regurgitation amenable to simple repairs that can be performed quickly with the robot. The ultimate role of robotics in mitral/tricuspid surgery will await additional experience in other centers and careful comparison with alternative approaches such as conventional sternotomy and thoracotomy without robotics. Yet, this paper demonstrates a successful model for applying a very new technology to a difficult group of patients in a hospital setting not traditionally associated with scientific advancement. Although any surgeon, group, or hospital may apply new technology such as robotic mitral and tricuspid repair to any patient they choose, successful outcomes may require the focus, judgment, and persistence over time seen in this report for ultimate success. Concomitant Robotic Mitral and Tricuspid Valve Repair: Technique and Early ExperienceThe Annals of Thoracic SurgeryVol. 97Issue 3PreviewRobotic mitral valve repair has been successfully performed since the late 1990s, but concomitant robotic tricuspid repair has not yet been widely adopted. We report our first 5 years' experience with concomitant robotic mitral-tricuspid valve repair. Full-Text PDF