title: Endoscopic placement of multiple artificial chordae with robotic assistance and nitinol clip fixation.
abstract: OBJECTIVE
  A totally endoscopic method of placing multiple premeasured artificial chordae with the assistance of the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, Calif) and V60 U-clip devices (Medtronic Inc, Minneapolis, Minn) was evaluated.
  
  
  METHODS
  Totally endoscopic placement of multiple artificial chordae with robotic assistance and nitinol clips was performed in 30 patients. After subvalvular exposure with a robotically controlled Atrial Retractor (Intuitive Surgical Inc), artificial chordae constructed of 4-0 polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc, Flagstaff, Ariz) were secured to the prolapsing leaflet edge with V60 U-clips. Transesophageal echocardiography to assess successful repair was performed.
  
  
  RESULTS
  Repairs of the anterior leaflet, the posterior leaflet, and combinations of both were performed. Crossclamp and cardiopulmonary bypass times were in the range of 78.63 +/- 17.03 minutes and 118.17 +/- 22.55 minutes, respectively. Transesophageal echocardiography showed grade 0 to less than grade 1 mitral regurgitation postoperatively. All patients had an uneventful recovery phase and were discharged within 5 days.
  
  
  CONCLUSIONS
  Endoscopic placement of premeasured artificial neochordae is greatly facilitated by applying robotic assistance and using nitinol clips for chordae fixation. The endoscopic robotic technique provides excellent functional and clinical outcomes.
authors.affiliation: Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA. amy_engel@trihealth.com
authors.forename: J Michael
authors.initials: JM
authors.lastname: Smith
authors.forename: Hubert
authors.initials: H
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001705:Bioprosthesis; D002815:Chordae Tendineae / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D012371:Robotics; D013525:Surgical Instruments; D013536:Suture Techniques; D016896:Treatment Outcome
chemical_list: D000497:Alloys; C013616:nitinol