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First Two Mitral Valve Replacements via Right Lateral Mini Thoracotomy Using New Automated Annular Suturing Technology
Victor S. Costache1, Juan A. Siordia, Jr.2, Charles J. Lutz3, Jude S. Sauer4, Peter A. Knight2.
1LB University of Sibiu, Next Cardio Project, Sibiu, Romania, 2University of Rochester Medical Center, Rochester, NY, USA, 3St. Joseph's Hospital, Syracuse, NY, USA, 4LSI Solutions, Victor, NY, USA.
OBJECTIVE: Minimally invasive mitral valve replacement (MI-MV replacement) remains a relatively uncommon procedure, at least partially due to the technical challenges of providing rapid and reliable mitral annular sutures. This report describes the first two MI-MV replacements performed in patients using automated precision suturing technology through a video-assisted right lateral mini-thoracotomy.
METHODS: After successfully using this new technology in minimally invasive aortic valve replacement patients, its application was explored for MI-MV replacement in the cadaver model. Subsequently, two patients underwent MI-MV replacements using this automated annular suturing technology. Both patients received cardiopulmonary bypass via right groin access. Exposure of the left atrium was achieved through a ~5cm right lateral thoracotomy with 5mm 30° videoscopy. An automated annular suturing device featuring a rotating shaft and an articulating distal tip with dual curved needles placed precise pledgeted 2-0 polyester horizontal mattress suture tissue bites through the mitral annulus. A second device with dual straight needles placed these sutures through the prosthetic valve suturing cuff. All automated device needles retract completely into protective sheaths when not deployed.
RESULTS: Automated suturing technology was effective in both patients for all annular and sewing cuff suture placements. In the first patient, 21 sutures were used to place a 31mm St. Jude mechanical valve and 22 in the second patient for a 33mm St. Jude mechanical valve without issue; aortic cross-clamp and cardiopulmonary bypass times were: 69 and 91, and 61 and 86 minutes, respectively. Both patients recovered well without complications and were discharged on postoperative day 4. Intraoperative post-replacement transesophageal echocardiography along with subsequent transthoracic echocardiography at approximately one week and two months confirmed excellent valve function without any paravalvular leaks.
CONCLUSIONS: The technical and clinical outcomes for the first two patients who underwent MI-MV replacement utilizing this new automated suturing technology are very encouraging. Further use and study of this approach is ongoing.
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