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

Abstract

Assisted bicaval venous drainage was accomplished with a percutaneous internal jugular 17F and a 23F femoral venous Bio-Medicus cannula (Medtronic Bio-Medicus, Eden Prairie, Minn). Arterial inflow was established via a transverse 2-cm groin incision. A 5-cm right inframammary incision in the fourth intercostal space was used. The pericardium was incised ventral to the phrenic nerve. A transthoracic aortic clamp (Scanlan International, Minneapolis, Minn) was placed through the third intercostal space. We have performed more than 120 manual videoscopic mitral valve operations safely by similar methods.3 Reconstructive mitral valve procedures require access, vision, and dexterity. Despite meteoric technical advances, surgeons remain reluctant to perform minimally invasive cardiac operations. Two-dimensional vision remains the major impediment to endoscopic cardiac operations. Additionally, small incisions result in a rotational axis for longer instruments, increasing tremor and diminishing accuracy. Robotic surgical instruments emulate the 7 degrees of freedom in the human wrist. In Europe, robotic devices have been used to repair mitral valves and perform coronary surgery safely.1,2 Herein, we describe a complex mitral valve repair done in North America, with the use of an articulated “wrist” robot. Patient preparation and perfusion methods. After institutional review board and Food and Drug Administration– Investigational Device Exemption protocol (#23) approval, informed consent was obtained from a 69-year-old woman with severe mitral insufficiency (class IV of the New York Heart Association). She had a 1.5-month history of atrial fibrillation. A transesophageal echocardiogram showed severe mitral insufficiency and a large P2 prolapse, secondary to ruptured/redundant chordae. The left ventricular ejection fraction was 55%, and the coronary arteries were normal. ROBOTIC MITRAL VALVE REPAIR: TRAPEZOIDAL RESECTION AND PROSTHETIC ANNULOPLASTY WITH THE DA VINCI SURGICAL SYSTEM