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Robotic Mitral Valve Repair Using Loop Technique
Yosuke Takahashi, Hiromichi Fujii, Akimasa Morisaki, Yoshito Sakon, Yuriko Kiriya, Noriaki Kishimoto, Kokoro Yamane, Takumi Kawase, Yosuke Sumii, Toshihiko Shibata.
Osaka City University Graduate School of Medicine, Osaka, Japan.

Objective: We present a series of robotic mitral valve repair using loop technique. Patients and Methods: We have performed 37 cases of the robotic mitral valve repair using loop technique since 2018. The port locations are as follows; service port (4 intercostal space), left arm trocar (3 intercostal space), right arm trocar (6 intercostal space), camera port (4 intercostal space) and atrial retractor port (4 or 5 intercostal space). Results: The reconstruction sites of mitral valve are posterior leaflet in 26 cases, anterior leaflet in 5 cases, and bi-leaflet in 7 cases (2cases were Barlow disease). We used flexible partial band or semi-rigid total ring for mitral annuloplasty. Patients age is from 22 years old to 89 years old. Mean length of service port is 5.3 cm. Mean console time is 174 min. Mean number of loop artificial chordae is 3.5 and 22 cases were reconstructed using loop from bilateral papillary muscle. Seven cases were performed an additional technique of simple height reduction (spindle resection of P2 portion along the mitral annulus) to prevent systolic anterior motion of mitral valve. Two cases were needed to establish second pump run and repair mitral valve for systolic anterior motion. Post-operative complications are as follows; one case was with pneumonia, two with paralysis of the phrenic nerve, and one with re-expansion of lung edema. Post-operative mitral regurgitation of 37 cases except one case are mild or less. One case was with severe MR due to SAM, resulting in re-mitral valve repair via median sternotomy. Conclusion: We performed robotic mitral valve repair using loop technique safely and successfully even in the patients complicated with bi-leaflet prolapse or Barlow disease.


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