Robotic Mitral Valve Repair - An Institutional Start-up
Erik Herou, Shahab Nozohoor, Igor Zindovic, Sigurdur Ragnarsson, Per Wierup, Mårten Larsson, Johan Sjögren.
Lund University Hospital, Lund, Lund, Sweden.
OBJECTIVE: Excellent long-term mitral valve repair outcomes in combination with early referrals for asymptomatic patients have shifted the focus toward less invasive options, including robotic repair. Outside of the largest centers, robotic programs can be seen as challenging to institute. We describe our mid size institutional start-up and early results.
METHODS: Skane University Hospital, Lund is a tertiary care teaching hospital whose cardiac surgery unit serves a population of approximately 1.3 milion people. Robotic assisted mitral valve repair (daVinci surgical system; Intuitive Surgical) was introduced in September 2012. Between September 2012 and December 2016 a total of 34 patients (mean age 54; range 31-73 years) underwent mitral valve repair through a right mini-thoracotomy with robotic support. Patients with concomitant coronary artery disease, known peripheral vascular disease or prior right thoracotomy were not accepted for robotic assisted mitral valve repair. Follow up was performed in December 2016 (mean follow up 18 months).
RESULTS: 30-day mortality was 0%. Two patients were reoperated for postoperative bleeding. The mean ECC time 2012-2014 (7 patients) and 2015-2016 (27 patients) was 221 +-72 and 186 +-54 min respectively and the mean cross clamp time was 152 +-43 and 96 +-26 min respectively. All patients had a succesful valve repair without significant regurgitation at discharge (none/trivial regurgitation), none were converted to sternotomy on the basis of failed mitral valve repair. The median length of stay in our ICU was 1 day and in our department 7 days. All patients were alive at late follow up. Three patients were reoperated with conventional mitral valve repair due to significant mitral regurgitation found on late follow up.
CONCLUSIONS: Our initial experience suggests that even with a limited amount of cases, robotic mitral repair may be performed with satisfying outcomes in selected patients. Operating time has been reduced with greater experience, however prolonged surgery did not seem to influence early and midterm mortality.
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