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OBJECTIVE: To minimize any learning curve accompanying the introduction of robotically assisted mitral valve repair (r-MVR) in our hospital, a comprehensive training, protocolling and proctoring program was adopted. This study evaluated all r-MVR outcomes in our hospital from the start in July 2012 till December 2014 in order to assess the effectiveness of our approach.
METHODS: Following the formation of a dedicated team, about 20 relatively simple intrathoracic non-cardiac procedures were performed. The ensuing r-MVR training program was supervised by an experienced center and included web based learning, training procedures on plastic hearts, endo-balloon training, case observations and comprehensive protocol generation. The first 3 cases were proctored. Criteria for a logical evolution from relatively simple to more complex cases were predefined.
RESULTS: Successful repairs were realized in all 52 patients with 0 mortality. Mean age was 61±11 [range: 31-80]. Repair techniques included neochord placement in 44 (85%), leaflet stitches in 11 (26%), leaflet reduction in 17 (33%) and an annuloplasty ring or band in all cases. In 9 cases, pulmonary vein isolation and left atrial appendage closure were performed as well for treating paroxysmal atrial fibrillation. The trend for decreasing crossclamp times (168±49’, range:74-309) was offset by the inclusion of increasingly complex cases, ranging from isolated P2-prolaps initially to complex bileaflet repairs including Barlow type valves later on. Residual leakage was zero to mild in 47 (90%), moderate in 3 (6%) and severe in 2 (4%). Two cases (4%) were redone conventionally. The major complications included hepatic bleeding necessitating laparotomy in one patient and an episode of cardiac failure, likely due to coronary air embolism, necessitating temporary mechanical circulatory support in another; both occurred in the first 6 patients and initiated a second round of proctoring (4 patients).
CONCLUSIONS: Using a carefully trained, dedicated team and a well protocolled program, robotically assisted mitral repair can be introduced relatively safely. Especially the first 10 odd patients appear to be at an increased risk for complications and deserve special attention.