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Implantation Of Annuloplasty Band With A Semi-Automated Suture Fastener: Enabling Technology For Complex Robotic Endoscopic Mitral Reconstruction
Muhammad J. Younus1, Faisal H. Cheema2, Karen Calcano3, Irving David3, Harold G. Roberts, Jr4.
1Aegis Cardiovascular Research Foundation, Fort Lauderdale, FL, USA, 2College of Physicians & Surgeons of Columbia University - New York Presbyterian Hospital, New York, NY, USA, 3Holy Cross Hospital, Fort Lauderdale, FL, USA, 4Aegis Cardiovascular Research Foundation & Holy Cross Hospital, Fort Lauderdale, FL, USA.
Purpose:
Even though robotic valvular surgery has become widely accepted, it is primarily restricted to simple mitral procedures. The robotic approach is generally not offered for complex mitral reconstruction owing to its steep learning curve and the concerns for prolonged clamp times. Here, we demonstrate a new enabling technology that utilizes a semi-automated suture fastener to markedly facilitate band implantation during advanced mitral reconstruction.
Methods:
A 60 year old male with severe bileaflet prolapse secondary to advanced Barlow's disease and chronic atrial fibrillation presented with NYHA Class-III symptoms and moderate left ventricular dysfunction. Echocardiography revealed a single P2 ruptured chorda tendina with a large central jet and gross annular dilatation with markedly redundant leaflet tissue and bileaflet prolapse. A totally endoscopic robotic assisted procedure comprising of bileaflet mitral reconstruction with a concomitant cryomaze was carried out. Using a semi-automated one-step titanium suture fastener, Cor-Knot ™ (LSI Solutions Inc. Victor, NY), a 38 mm flexible annuloplasty band was secured in place with multiple 2-0 polyester braided sutures. Pre- and post-repair 2D and 3D transesophageal echocardiographic (TEE) images were obtained.
Results:
This surgical video demonstrates the one-shot tying of the sutures using a semi-automated device. Avoiding the need for tying multiple knots on each suture during annuloplasty band insertion helps reduce cardiopulmonary bypass and aortic cross clamp times. Post-operative TEE revealed a competent valve with no residual regurgitation. Postoperative course was uneventful and the patient was discharged in 3 days with a normal sinus rhythm.
Conclusions:
This novel semi-automated device allows for a one-step secure fastening of sutures without the need for tying knots thereby providing both efficiency and equal tension across the annuloplasty band. It represents an additional enabling technology for robotic endoscopic mitral reconstruction.
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