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OBJECTIVE: We studied the results of our first 120 cases during a period where totally endoscopic robotic mitral valve surgery became our standard approach for nearly all patients requiring mitral valve procedures. We define totally endoscopic robotic mitral valve surgery as that in which no portion of the procedure can be performed through direct visualization through any incision (working port 15 mm for repair, 30 mm for replacement). Our relative exclusion criteria were minimal: extreme high risk patients, severe mitral annular calcification, severe right chest adhesions, ascending aortic aneurysm > 4 cm, and concomitant disease requiring an open approach. There were no absolute exclusion criteria other than inoperability.
METHODS: Our group conducted a retrospective chart review of all patients during the study period who underwent robotic mitral valve surgery at our institution. Procedures included a broad spectrum of surgical management including leaflet repairs, augmentations, mitral replacements, and concomitant procedures including concurrent tricuspid repair, MAZE procedures and atrial septal defects.
RESULTS: The average age of the patients was 61±13 years. The ejection fractions were >50% EF- 61%; 35-50% EF- 25%; and <35% - 14%. Average operative time was 254±44 min, CPB was 129±39 min and cross clamp time was 82±32 min. 8 (6%) patients were converted to an open procedure (either thoracotomy or sternotomy) primarily for unanticipated right chest adhesions. 94% of patients underwent repair and 6% replacement. 20% had concomitant intracardiac procedures. Our average length of stay was 6.9±4.4 days. 1 patient had permanent stroke who also died. During the study period at our institution, there were only 3 patients who underwent primary sternotomy for mitral surgery due to previous lung surgery, severe mitral annular calcification, and preoperative acute cardiogenic shock requiring ecmo.
CONCLUSIONS: We demonstrate that totally endoscopic robotic mitral surgery can be used as the first choice for treatment of nearly all isolated mitral valve disease requiring surgery rather than only for select patients.