Robotic mitral valve replacement for rheumatic mitral disease.

Abstract

Eden Prairie, MN, USA) and the CFV was cannulated with a 24-Fr venous cannula (Medtronic Bio-Medicus, Eden Prairie, MN, USA) using the Seldinger technique and TEE guidance. The tip of the venous cannula was placed 1 cm superior to the cavoatrial junction. A 3 cm incision was made between the anterior axillary line and midclavicular line at the fourth intercostal space. The right lung was deflated and a small soft tissue retractor (Applied Medical, Rancho Santa Margarita, CA, USA) was placed. The camera port was inserted through this soft tissue retractor. The right arm port was placed one or two intercostal spaces inferior to the soft tissue retractor, and the left arm port was placed one intercostal space superiorly. The sites for the two arms were placed in a line perpendicular to the incision at the fourth intercostal space. The left atrial retractor port was placed 3 cm medial to the soft tissue retractor in the same intercostal space. The robotic arms were connected to the ports. Carbon dioxide insufflation was applied at a pressure of 6 mmHg and a flow rate of 6 L/min. After the institution of cardiopulmonary bypass, the pericardium was opened with an incision starting 2 cm anterior and parallel to the phrenic nerve. Two pericardial retraction sutures were passed through the lateral chest wall and fixed externally. The transverse sinus of pericardium was controlled with the tip of a suction device for detection of any possible adhesions at the posterior wall of the ascending aorta. A transthoracic Chitwood aortic clamp was inserted through the chest wall in the direction of the transverse sinus. The inferior jaw of the clamp was placed in the transverse sinus. A temporary needle for cardioplegia was placed in the ascending aorta through the soft tissue retractor. The ascending aorta was clamped with the transthoracic clamp.