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Learning Curve In Robot Assisted Mitral Valve Repair
Daiki Yoshiyama, Yoshitsugu Nakamura, Yuto Yasumoto, Shuhei Nishijima, Miho Kuroda, Taisuke Nakayama, Ryo Tsuruta, Yujiro Ito.
Chiba-Nishi General Hospital, 107-1 Kanagasaku-cyo Matsuyoshi Chiba-ken 270-2251, Japan.
BACKGROUND: We introduced robot assisted mitral valve repair (RMVR) in June 2018. The study objective was to assess the clinical outcomes of RMVR in the first 100 cases and to assess its learning curve. METHODS: We reviewed the first 100 patients (after 6 cases with proctoring) who underwent RMVR, including concomitant procedures (maze, left arterial appendage closure, patent foramen ovale), from June 2018 to July 2020. RMVR concomitant with tricuspid valve repair during in this period was excluded. Patients were divided into the first 50 patients [1-50 cases: E group (n = 50)] and the last 50 patients [51-100 cases: L group (n = 50)] . RESULTS: The mean age was 65 ± 14 years, 46 patients were female, BSA was 2.0 ± 0.2, euroSCORE2 was 2.0 ± 1.8, New York Heart Association class (NYHA) 3 or 4 was 30 patients (30%). Concomitant procedures included atrial fibrillation ablation (21%), and left arterial appendage closure (32%), patent foramen ovale closure (5%). Annuloplasty with prosthetic was performed in 99 patients (99%) Flexible bands was used in 67(67.7%), while rigid band was used in 32 patients (32.3%). Horizontal mattress technique was used in 52 (52.5%), interrupted was used in 47(47.5%). Mean band size was 30.5±2.2mm. Repair techniques included neochordae placement (53%), leaflet resection (43%), Edge to Edge (18%), folding technique(24%). There was no in-hospital or 30-day mortality. Postoperative complications included one reexploration for bleeding (1%), 1 stroke (1%), 1 subarachnoid hemorrhage (1%), 3 postoperative hemolysis(3%). 1 patients required surgical re-intervention with mitral valve replacement due to moderate mitral regurgitation (1%). After operation, the mitral regurgitation was graded as none or trivial in 96 patients (96%).We were found in the L group that shorter operative time (254.5 ± 46.3 min vs. 218.3 ± 39.3min, P<0.001), cardiopulmonary bypass time (177.6 ± 39.0 min vs. 147.7 ± 33.9 min, P < 0.001) and aortic cross-clamp time (144.3 ± 36.1 min vs. 118.3 ± 26.3 min, P < 0.001). CONCLUSIONS:The clinical outcomes of RMVR was satisfactory in the initial 100 cases even though first 50 cases required significantly longer operation, cardiopulmonary bypass and aortic cross-clamp time. 
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