Robotic repair of mitral valve

Brief Review

Abstract: Robotic repair of mitral valve is a promising minimally invasive surgical approach for both simple and complex mitral valve regurgitation, with excellent results.

Robotic repair of mitral valve is a minimally invasive approach compared to conventional mitral valve repair, which itself is an option against mitral valve replacement. Robotic and conventional mitral valve repairs are considered mostly for degenerative mitral valve disease as opposed to rheumatic mitral valve disease in which scarring often precludes a good repair and replacement is often the only option available. Mitral valve repair gives good results while addressing disease involving a single scallop of the mitral valve. Though standard mitral valve repair uses midline sternotomy, minimally invasive repair using right anterior thoracotomy also gives comparable results.

Robotic mitral valve repair has been shown to be feasible for quite some time [1]. One of the initial reports evaluated 38 patients with nonischemic moderate to severe mitral insufficiency [2]. Intraoperative three dimensional echocardiography guidance was available during robotic mitral valve repair. 3-D reconstructions allowed good repair and assessment of mitral valve intraoperatively. There were no deaths or stroke during surgery. Average hospital stay was 3.8 days. All patients had successful robotic mitral valve repair. One patient required valve replacement due to hemolysis and another needed re-exploration due to bleeding.

Hundred cases of prospectively studied robotic mitral valve repair for all categories of mitral valve repair was reported by Suri RM et al [3]. Most of the last 25 patients could be extubated from the operating room itself. There were no operative deaths and one patient underwent reoperation for mitral annuloplasty ring dehiscence. All patients had good results with mitral regurgitation of mild or lesser degree. Significant reduction in left ventricular size was documented at one month follow up.

A recent report has expanded the base of robotic mitral valve repair further [4]. A total of 487 cases from January 2008 to January 2015 has been analysed. While about 60% had simple pathology, the rest had complex repair. Eight patients had recurrence of moderate or more mitral regurgitation, four each in simple and complex repair groups. Seven patients underwent mitral reoperation, 2 in simple and 5 in complex repair groups. Four patients died during follow up, giving a 5 year survival of 99.5%. New York Heart Association (NYHA) functional class I or II was achieved in 97.9% of cases.

References

  1. Chitwood WR Jr, Nifong LW, Elbeery JE, Chapman WH, Albrecht R, Kim V, Young JA. Robotic mitral valve repair: trapezoidal resection and prosthetic annuloplasty with the da vinci surgical system. J Thorac Cardiovasc Surg. 2000 Dec;120(6):1171-2.
  2. Nifong LW, Chu VF, Bailey BM, Maziarz DM, Sorrell VL, Holbert D, Chitwood WR Jr. Robotic mitral valve repair: experience with the da Vinci system. Ann Thorac Surg. 2003 Feb;75(2):438-42; discussion 443.
  3. Suri RM, Burkhart HM, Rehfeldt KH, Enriquez-Sarano M, Daly RC, Williamson EE, Li Z, Schaff HV. Robotic mitral valve repair for all categories of leaflet prolapse: improving patient appeal and advancing standard of care. Mayo Clin Proc. 2011 Sep;86(9):838-44.
  4. Suri RM, Taggarse A, Burkhart HM, Daly RC, Mauermann W, Nishimura RA, Li Z, Dearani JA, Michelena HI, Enriquez-Sarano M. Robotic Mitral Valve Repair for Simple and Complex Degenerative Disease: Mid-Term Clinical and Echocardiographic Quality Outcomes.Circulation. 2015; 132: 1961-1968.