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Robotic Endoscopic Re-repair Of Recurrent Mitral Regurgitation: A Case Series
Yazan AlJamal1, Sarah Nisivaco2, Husam H. Balkhy3.
1Mayo Clinic, Rochester, MN, USA, 2Northwestern Medical Center, Chicago, IL, USA, 3University of Chicago, Chicago, IL, USA.
Introduction: Robotic-assisted cardiac surgery has expanded the options for minimally invasive mitral valve (MV) repair, though limited literature exists on robotic re-repair for recurrent mitral regurgitation (MR). This series highlights the safety and feasibility of successful redo-robotic MV re-repair, emphasizing benefits, and potential for standardizing this approach.Methods: We performed 650 robotic endoscopic mitral valve (MV) repairs between September 2013 and August 2025. Among these patients, 53 had a history of previous cardiac surgery, including 32 with prior mitral valve surgery. Of these, 19 had previously undergone mitral valve repair. Seventeen (17) of these patients subsequently underwent mitral valve re-repair and form the focus of this study.A standardized, endoscopic robotic-assisted approach is used with the da-Vinci-Xi surgical system (IntuitiveSurgical,Inc.). Single-lung ventilation is achieved using a right bronchial blocker. A 5-mm port and scope is placed in the right chest away from the previous scar to evaluate lung adhesions. CO2 insufflation is used to expand the chest. A second thoracoscopic port is placed if necessary to dissect adhesions to the chest wall enough to place standard robotic ports. Femoral artery and vein cannulation were guided by TEE for CPB. Lung adhesions to the heart are dissected robotically on CPB.Results: The mean age was 55.3 years, and 4 patients (27%) were female. Robotic totally endoscopic re-repair of recurrent MR was achieved in all patients. The mean STS risk of mortality was 2.4% (range,0.43%-6.4%). There were no conversions to sternotomy or reoperation for bleeding. The ICU and hospital LOS were 1.2 days and 2.3 days respectively. Postoperative echocardiography revealed no or trace residual MR in 10-patients, mild residual MR in 4-patients and moderate residual MR in 1-patient. Midterm follow-up, at a mean of 30 months (longest 10-years) with 0% mortality.Conclusion: This series demonstrates the feasibility of a standardized robotic endoscopicre-repair approach for recurrent MR, offering a viable alternative to sternotomy with quicker recovery and improved outcomes. Further studies are recommended to validate this technique.
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