Beating Heart Robotic Mitral Valve Reoperations
Cengiz Bolcal, Murat Kadan, Outside US/Canada/Australia, Gokhan Erol, Emre Kubat, Mehmet Emin Ince, Vedat Yildirim.
Gulhane Medical Faculty, Ankara, Turkey.
PurposeRobotic surgery is innovative, favourable and promising procedure for appropriate heart surgery candidates. Reoperations are a challenging issue for cardiac surgeons due to higher risk of myocardial injury, graft injuries and perioperative hemorrhage. There is no case about beating heart robotic assisted mitral valve replacement reoperation in the literature. Methods We performed eight beating heart robotic assisted mitral valve reoperation via robotic cardiac surgery system. Previous operations were CABG (1 patients), mitral valve replacement (1 patient), mitral valve repair (3 patients), and aortic valve replacement (3 patients). Due to inaccessibility to clamping of the ascending aorta through right anterolateral minithoracotomy, we had to perform mitral valve reoperations during beating heart. The key point is use of two sump suctions, one of them is in the left ventricle and the other is in the left atrium. We don't pull out the left ventricle sump suction until the closure of left atrium. Results As a result of the sump suction in the left ventricle, aortic valve does not opens and we can detect air bubbles in the left atrium and ventricle with transesophageal echocardiography (TEE). Circulation between left atrium and left ventricle creates a chamber, we pull out the left ventricle sump suction when air bubbles totally gone. We have not seen any neurological complications. Postoperative drainage (mean: 185,7 ± 99,8ml), ventilation time (mean: 8,3 ± 3,7hours), amount of blood product usage (1,1 ± 1,3units), intensive care unit stay time (mean: 2,1 ± 1,2days), hospital stay time (mean: 8,4 ± 4,3days) were less than conventional mitral valve replacement reoperations via median sternotomy (p<0,05) and as similar as non-reoperated mitral valve replacement patients even if euroscores were higher in reoperative patients. Return to daily life is shorter with robotic cardiac surgery. Conclusions Beating heart robotic mitral valve replacement is a safe and suitable method for reoperations. Intracardiac chamber while sump suction in the left ventricle provides minimal air bubble embolization so that conventional mitral valve replacement can send out more air bubbles to the circulation.
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