Robotic Mitral Valve Replacement: 6-year Single Centre Experience And Follow-up Results
Rong Wang, Huajun Zhang, Changqing Gao.
PLA General Hospital, Beijing, China.
Background: Robotic mitral valve replacement (MVR) is ideal for selected patients with rheumatic etiology. This study aims to summarize the surgical experience with robotic MVR over the last 6 years and demonstrate the long-term clinical follow-up results. Methods: From October 2008 to September 2014, a total of 42 patients underwent robotic mitral MVR with da Vinci Surgical System (Intuitive Surgical, USA) in our center. The patients' average age was 47±11 years with male to female ratio 0.9. The median heart function was under NYHA class II and 47.6% (n=20) had atrial fibrillation on admission. Rheumatic mitral stenosis (MS) was diagnosed in two thirds of the patients (n=28), of whom half had mitral regurgitation (MR, n=14). One third of the patients (n=14) had MR unsuitable for repair among whom two were caused by infective endocarditis. Atrial septal defect (0.7cm in size) co-existed in one case and one patient had mild aortic regurgitation. Mechanical or bioprosthetic mitral valve was replaced via left atriotomy by using the da Vinci robot after CPB setup. Radiopaque titan clips was applied by Cor-Knot knot-tying device (LSI Solutions, Inc, Victor, NY) to anchor the prosthetic valve. Trans-esophageal echocardiography (TEE) was performed before and after surgery. The operative data were collected and patients were followed at outpatient clinic regularly up to 6 years. Results: All cases were performed successfully by the same surgeon. No conversion to median sternotomy or operative mortality occurred. The average operation time was 292±62 minutes (ranged, 140 to 450 minutes) with CPB time 124±26 minutes and aorta cross-clamping time 88±21 minutes. After surgery, the mechanical ventilation support was continued for 15±6 hours and the average critical care unit stay was 4±1 days. No myocardial infarction, ventricular tachycardia or excessive bleeding was complicated. All patients were successfully followed for a median of 3.5 years (range, 1 month to 6 years). In the follow-up period, no incidence of death, stroke, re-operation due to prosthetic endocarditis or prosthetic failure was reported. However, 40.4% (n=17) still had atrial fibrillation after surgery. Conclusions: Robotic MVR is a safe and effective procedure with excellent long term surgical outcome.
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