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Robotic Mitral Valve Repair: A Single Institutional Series of 853 Procedures
L Wiley Nifong, Hazaim Alwair, Kaushik Mandal, Aseem Srivastava, W. Randolph Chitwood, Jr..
East Carolina Heart Institute at East Carolina University, Greenville, NC, USA.

OBJECTIVE: Minimally invasive mitral valve surgery has become the standard of care at many institutions. Moreover, robot-assisted mitral valve repair (RAMV) also has become established in large institutions in the United States. We reviewed our experience of 853 RAMVs over 14.5 years.
METHODS: Data variables on all operative cases were collected prospectively and entered into a secure database. We reviewed all RAMVs done at our institution from May 2000 through November 2013. Our preoperative assessments as well as patient positioning and robotic set-up were standardized. Variables reviewed included cardiopulmonary bypass (CPB) and cross clamp times (XC) as well as post-operative outcomes, including successful repair rates and complications.
RESULTS: A total of 853 patients (363 women) underwent RAMV repairs. Previous cardiac surgery had been performed in 35 (4.0%). Mean age was 59.4 ± 13.1 years. Comorbidities included AFib (n=290, 34.0%), hypertension (n=429, 50.3%), CAD (n=112, 13.1%), CHF (n=607, 71.2%), pulmonary hypertension (n=236, 27.7%), prior stroke (n=29, 3.4%), and endocarditis (n=31, 3.6%). CPB and XC times were 159.3 ± 44.0 and 113.9 ± 31.5 minutes, respectively. One or more concomitant procedures performed included PFO closure (n=114, 13.4%), cryomaze (n=223, 26.1%), left atrial appendage suture closure (n=218, 25.6%), and tricuspid valve repair/replacement (n=11, 1.3%). Repairs included leaflet resections (LR) with or without a chordal procedure (CP) (n=402, 47.1%), CP only (n=102, 12.0%), LR with sliding valvuloplasty (n=112, 13.1%), annuloplasty only (n=103, 12.1%) and other (n=134, 15.7%). All patients had a band annuloplasty. Post-op TEE MR grade was 818 (95.9%) none or trivial, 25 (2.9%) mild, seven (0.8%) moderate and none with severe. The 30-day mortality was 1.3% (n=11). There were no aortic dissections or peripheral vascular complications. Complications included eight strokes (0.9%), seven peri-operative myocardial infarctions (0.8%), and 26 re-explorations for bleeding (3.0%). The mean length of hospital stay was 5.4 days. A total of 24 patients (2.8%) required a later MV reoperation.
CONCLUSIONS: RAMV repair alone or in combination with other cardiac procedures is safe and reproducible with excellent results. Case volume, surgeon repair expertise, and team synergy are critical in maintaining proficiency and to achieve optimal robotic mitral valve repair outcomes.

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