title: Robotic mitral valve repair for anterior leaflet and bileaflet prolapse.
abstract: BACKGROUND
  Centers have expanded indications for robotic mitral valve repairs to include complex pathologic features. We studied our results after robotic mitral valve repair for anterior leaflet or bileaflet prolapse.
  
  
  METHODS
  Data were collected contemporaneously on 289 patients operated on from May 2000 to September 2006. Every patient underwent preoperative transesophageal echocardiography. Follow-up consisted of serial echocardiograms, clinic visits, and phone conversations with patients and their physicians.
  
  
  RESULTS
  A total of 66 patients (anterior leaflet, n = 14; and bileaflet, n = 52) were identified. Mean age was 52.6 +/- 7.1 years, and 57 (86%) patients had New York Heart Association functional class II or III symptoms. Cardiopulmonary bypass and cross-clamp times were 171 +/- 52 and 132 +/- 39 minutes, respectively. The 30-day and late mortality rates were 3% (n = 2) for each time point. There were no device-related or perfusion-related complications or sternotomy conversions. Complications included 2 strokes (3%), 2 bleeding reexplorations (3%), and 10 pleural effusions requiring intervention (15%). The length of hospital stay for surviving patients was 5 +/- 3 days, and time to extubation averaged 9.5 +/- 13 hours. A total of 6 (9%) patients required valve reoperation. Mean follow-up was 795 +/- 495 days, and echocardiographic mitral regurgitation (n = 60) was none or trace (n = 35, 58.3%), mild (n = 19, 31.6%), moderate (n = 2, 3.3%), and severe (n = 4, 6.7%).
  
  
  CONCLUSIONS
  Robotic mitral valve repair for anterior leaflet and bileaflet prolapse is feasible and safe. Outcomes and degree of late mitral regurgitation are similar to series using conventional techniques. Long-term follow-up is required to formally address the efficacy of robotic repair techniques.
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA. rodrigueze@ecu.edu
authors.forename: Evelio
authors.initials: E
authors.lastname: Rodriguez
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.forename: William
authors.initials: W
authors.lastname: Wood
authors.forename: Paul W
authors.initials: PW
authors.lastname: Vos
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics / Q000295:instrumentation*; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome