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Robotic Mitral Valve Repair Using An Indigenous Ssi Mantra Robotic System
Lalitaditya Malik, Mch( CTVS).
Manipal Hospital, jaipur, India.
BACKGROUND: Isolated P2 prolapse is the most common etiology of degenerative mitral regurgitation and is ideally suited for repair. Robotic platforms enhance precision in leaflet and subvalvular reconstruction through a minimally invasive approach. We describe our standardized technique for robotic mitral valve repair of P2 prolapse using the SSI Mantra, an indigenously developed robotic surgical system, in combination with a Memo 4D annuloplasty ring.
METHODS: Patients with isolated degenerative mitral regurgitation due to P2 prolapse were selected. Procedures were performed via four port with a small working wound , using peripheral cardiopulmonary bypass. Following left atriotomy, systematic valve analysis was undertaken. Repair was primarily achieved using expanded polytetrafluoroethylene (ePTFE) neochordae placed from the papillary muscle to the free edge of the prolapsing P2 segment, with chordal length adjusted with Memo 4D ring , and very easy to use in robotic cases. Repair adequacy was assessed with saline testing and intraoperative transesophageal echocardiography.
RESULTS: The SSI Mantra system provided stable three-dimensional visualization and precise wristed instrumentation, allowing accurate neochordal placement and secure annuloplasty ring implantation. All valves were successfully repaired with no or trivial residual mitral regurgitation on intraoperative echocardiography. There were no conversions to sternotomy, and early postoperative recovery was uneventful.
CONCLUSIONS: Robotic mitral valve repair for isolated P2 prolapse using the SSI Mantra Indian robotic system and Memo 4D annuloplasty ring is safe, reproducible, and effective. Neochordal reconstruction combined with dynamic annuloplasty enables leaflet preservation and durable repair while delivering the benefits of a minimally invasive robotic approach.
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