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Robotic mitral valve replacement for severe rheumatic mitral disease; perioperative technique, outcomes and early results
Sahin Senay1, Ahmet Umit Gullu1, Muharrem Kocyigit2, Aleks Degirmencioglu2, Hasan Karabulut1, Cem Alhan1.
1Acibadem University School of Medicine, Istanbul, Turkey, 2Acibadem Maslak Hospital, Istanbul, Turkey.

OBJECTIVE: Recent advances in technology have made robotic totally endoscopic mitral valve repair feasible. However robotic technique may be challenging when the valve pathology is not suitable for repair and replacement is inevitable. We report a case series of robotic mitral valve replacement in patients with severe rheumatic mitral disease.
METHODS: From March 2010 to December 2012, a total of 43 patients underwent robotic cardiac procedures. Robotic procedures were performed using the da Vinci Si surgical telemanipulation systems (Intuitive Surgical, Inc, Sunnyvale, CA). Twelve of the patients (27.9%) underwent robotic mitral valve replacement with or without additional cardiac procedure (tricuspid valve replacement/ tricuspid valve repair/ left atrial radiofrequency ablation). Rheumatic disease was the underlying pathology in all patients. Mean follw up period was 13±12 months.
RESULTS: Mean age and Euroscore (%) of the patients were 52±11 and 4.3±7. Six patients (50%) had additional cardiac procdure. No operative and hospital mortality was observed. Mean cross clamp time and cardiopulmonary bypass time were 131±40 and 191±60 minutes. Ten of the patients (83.3%) was discharged from the intensive care unit within the postoperative first 24 hours. During the intensive care unit stay one patient (8.3%) needed prolonged ventilatory support and one patient (8.3%) needed inotropic support. There was one (8.3%) intensive care unit readmission and one (%8.3) hospital readmission observed. During the follow up there was no mortality and no need for reoperation or reintervention.
CONCLUSIONS: Robotic mitral valve replacement for severe rheumatic mitral disease is technically feasible. Early results are encouraging.


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