title: Robotic mitral valve repair: a community hospital experience.
abstract: Robotically assisted cardiac surgery has been presented as less invasive than conventional surgery, with shortened hospital stays and faster return to daily activities. We evaluated our experience with the da Vinci robot to determine whether we could in fact demonstrate those findings. All mitral and tricuspid valve repairs were performed by the same surgeon. Cardiopulmonary bypass was performed with femoral cannulation, antegrade cardioplegia, and transthoracic aortic cross-clamping. Multiple valve repair techniques were used, including quadrant resection, cord replacement, Alfieri leaflet coaptation, and ring annuloplasty. Access was by 2 ports and a 5-cm right anterolateral thoracotomy. All annuloplasty rings were secured using surgical clips. From October 2003 through September 2004, 32 patients underwent robotically assisted mitral valve repair. The mean age of our population was 676 years (range, 43-82 years). Four patients also underwent the 1st tricuspid valve repair using the da Vinci robot in the United States. There were 3 conversions for irreparable valves, 1 stroke, and 2 deaths. The average procedure time, cardiopulmonary bypass time, and aortic cross-clamp time were all reduced, when the first 20 patients were compared with the last 12. Length-of-stay also improved. One patient required early mitral valve replacement for recurrent regurgitation. Two patients required late (> 3 month) mitral valve replacement for recurrent regurgitation. We have shown that a dedicated nonacademic institute can develop a robotic cardiac surgery program and perform mitral and tricuspid valve repairs successfully. There is a several-case learning curve, and patient selection is paramount.
authors.affiliation: BryanLGH Heart Institute, Lincoln, Nebraska 68516, USA. JonesBS3@aol.com
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Jones
authors.forename: Steve
authors.initials: S
authors.lastname: Krueger
authors.forename: Derek
authors.initials: D
authors.lastname: Howell
authors.forename: Barbara
authors.initials: B
authors.lastname: Meinecke
authors.forename: Shannon
authors.initials: S
authors.lastname: Dunn
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000295:instrumentation / Q000379:methods; D002315:Cardiopulmonary Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D012371:Robotics; D013997:Time Factors; D014261:Tricuspid Valve / Q000601:surgery