title: Significant reduction in annuloplasty operative time with the use of nitinol clips in robotically assisted mitral valve repair.
abstract: OBJECTIVE
  A substantial barrier to widespread adoption of robotically assisted mitral valve repair surgery is increased operative time compared with that of median sternotomy. Nitinol U-clips (Medtronic, Minneapolis, Minn) made of a shape-memory alloy eliminate intrathoracic suturing and may reduce operative times.
  
  
  METHODS
  A retrospective review of robotically assisted mitral valve repair surgery was done at East Carolina University, where preoperative, intraoperative, and postoperative data were collected prospectively. The total time for U-clip or suture placement, as well as those for cardiopulmonary bypass, crossclamp, and annuloplasty band placement, were studied. Patients in whom only U-clips were used ("U-clips" cohort) were compared with those in whom only sutures were used ("sutures" cohort). Comparisons between groups were by two-tailed Student t test.
  
  
  RESULTS
  Between May 2000 and June 2004, U-clips were used exclusively in 50 patients (mean age 58.4 +/- 13.2 years), and sutures were used exclusively in 72 patients (mean age 56.2 +/- 12.9 years). The mean total time for placement and deployment of U-clips was shorter than for placement and tying of sutures (101 +/- 45 seconds vs 186 +/- 79 seconds, respectively, P < .001). Cardiopulmonary bypass, crossclamp, and annuloplasty band placement times were shorter in the U-clips cohort (144 +/- 50 minutes vs 169 +/- 35 minutes, 105 +/- 30 minutes vs 132 +/- 29 minutes, and 26 +/- 5 minutes vs 40 +/- 10 minutes, U-clips vs sutures, respectively, all P < .01).
  
  
  CONCLUSIONS
  Significantly shorter times were observed for placement and deployment of U-clips versus placement and tying of sutures, resulting in a reduction in mean band placement time of 14 minutes and significantly shorter cardiopulmonary bypass and crossclamp times in the U-clips cohort. Therefore, use of Nitinol U-clips instead of sutures may allow for significantly faster robotically assisted mitral valve repair surgery.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Cook
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Enterkin
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Charland
authors.forename: Clifton C
authors.initials: CC
authors.lastname: Reade
authors.forename: Alan P
authors.initials: AP
authors.lastname: Kypson
authors.forename: Saqib
authors.initials: S
authors.lastname: Masroor
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
mesh_terms: D000497:Alloys; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012371:Robotics; D013525:Surgical Instruments; D013537:Sutures; D013997:Time Factors
chemical_list: D000497:Alloys; C013616:nitinol