Robotic Mitral Valve Surgery and Unilateral Pulmonary Edema

Abstract

This chapter describes robotic or minimally invasive mitral valve surgery, which was pioneered in 1998 to be the less invasive approach to sternotomy-based mitral valve operations. Patients undergoing robotic valve surgery carry a similar risk of complications that may occur with traditional median sternotomy surgery, but minimally invasive valve surgery has its own inherent complications associated with cardiac access, perfusion, and ventilation methods used in robotic surgeries. Unilateral pulmonary edema (UPE) is an uncommon but potentially life-threatening complication of robotic mitral valve surgery. The incidence of unilateral lung injury, which commonly manifests as UPE, has been reported to be quite variable. The variation in incidence could be related to the difference in patient populations, diagnostic criteria, as well as management. Moreover, the pathophysiology of UPE associated with robotic mitral valve repair remains unclear. The current literature suggests that UPE can be prevented by shorter cardiopulmonary bypass times, avoiding barotrauma, limiting blood product transfusion, and minimizing lung isolation times. Lung preventive ventilation, such as low-level positive pressure and frequent alveolar recruitment, while on cardiopulmonary bypass may be beneficial. Meanwhile, treatment for UPE is dependent on the severity of symptoms.