Robotic Mitral Repair Research Articles

Haircut mitral valve repair: posterior leaflet-plasty.

Robotic mitral valve repairs of the posterior leaflet can be difficult, especially when a very large P2 segment exists. The repair described in this chapter is a simplification technique we call a “Haircut” posterior leaflet-plasty. The advantages are preservation of annular leaflet continuity, shortening P2 (height reduction), resection of flail segment portions, and restoration of leaflet support either with existing or transposed chords. This method helps a great deal when performing a posterior leaflet robotic mitral repair.

Robotic mitral valve repair in infective endocarditis.

Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitral endocarditis the repair become more challenging especially in minimally approach. We applied robotic surgery in mitral endocarditis repair and reviewed our surgical methods and results. From January 2012 to December 2013, 12 patients with mitral endocarditis in National Taiwan University Hospital were operated via robotic assisted repair. Age of them was among 21 to 65 years old, mean 43. The vegetation involves anterior leaflet in 3, posterior leaflet in 8 and commissural leaflet in 4. Mean cardiopulmonary bypass time is 124 minutes and cross clamp time is 89 minutes. There was no stroke and no operation death. Mitral valve repair technique including anterior leaflet patch augmentation in 2, direct closure of rupture hole on anterior leaflet in one, plication commissural leaflet in 2, and artificial chordae in 10. There was no mitral regurgitation detected immediately after weaning of cardiopulmonary bypass. All of them got free-from-regurgitation or -stenosis rate was 100% at one-year follow. Although mitral infective endocarditis is complex and difficult to repair, robotic mitral repair in infective endocarditis is feasible. Even in the complex repair group, the cardiopulmonary bypass time is not prolonged and the result is good.

Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: Establishing the benchmark against which percutaneous interventions should be judged

Recent reports have shown that robotic mitral valve repair is effective in treating posterior leaflet disease; however, comparison with trans-sternal (open) valvuloplasty for all prolapse categories has not been performed. Moreover, data from the recently published EVEREST II trial infer that adverse event rates after mitral valve repair for degenerative disease are high. We therefore compared early outcomes of robotic versus open mitral valve repair for patients with mitral valve prolapse. Among 745 consecutive patients undergoing open or robotic mitral repair for degenerative disease, 95 propensity-matched pairs were identified. Leaflet prolapse categories were similar between groups. Complete mitral valve repair was performed using identical techniques. Median crossclamp and bypass times were longer in the robotic group but decreased significantly over time (P < .001). There were no conversions to open sternotomy, repair rate and early survival were 100%, dismissal mitral regurgitation grade was similar (P = 1.00), and all patients in the robotic group had mild or less mitral regurgitation at 1 month after repair. There were no differences in adverse events (5% open vs 4% robotic, P = 1.00). Patients in the robotic group had shorter postoperative ventilation time, intensive care unit stay, and hospital stay. Robotic mitral valve repair allows complete anatomic correction of all categories of leaflet prolapse using techniques identical to open approaches. Robotic repair effectively corrects mitral regurgitation, offers excellent freedom from adverse events, and facilitates rapid weaning from ventilation, translating into earlier hospital dismissal. Safety and efficacy after both open and robotic mitral valve repair are higher than recently reported in the EVEREST II trial and establish a benchmark against which nonsurgical therapies should be evaluated.

A Cost-analysis Study of Robotic Versus Conventional Mitral Valve Repair

Robotic mitral valve repair has been performed in Australia since 2004. The aim of this study was to perform a cost-analysis of robotic mitral valve repair (MVR) with direct comparison to conventional MVR surgery. All isolated MVRs performed within one metropolitan hospital network, between June 2005 and June 2008, were retrospectively compared. Ad hoc cost analysis was conducted. There were 107 robotic and 40 conventional MVRs performed. The post-operative degrees of mitral regurgitation were comparable. Total operating time was 18% longer in robotic compared to conventional (239 min vs. 202 min, p<0.001, 95% CI: 11-27%). In robotic, Intensive Care Unit stay was reduced by 19% (p=0.002, 37 h vs. 45 h), and length of hospital stay was reduced by 26% (p<0.001, 6.47 days vs. 8.76 days). Mean hospital cost, without including capital costs, was not significantly increased (AUD$18,503 vs. AUD$17,880 p=0.176, 95% CI: -282 to 1,530). Robotic mitral repair can be performed with similar immediate repair success rates as conventional surgery with a shorter recovery time, but a slightly longer operative time. There is no significant increase in cost over conventional surgery.