title: Robotic mitral valve repairs in 300 patients: a single-center experience.
abstract: OBJECTIVE
  Mitral valve repair is the standard therapy for patients with degenerative (myxomatous) disease and severe mitral regurgitation. Robotic mitral valve repair provides the least-invasive surgical approach. We report the largest single-center robotic mitral valve repair experience.
  
  
  METHODS
  Between May 2000 and November 2006, 300 patients underwent a robotic mitral valve repair (daVinci Surgical System; Intuitive Surgical, Inc, Sunnyvale, Calif). All operations were done with 3- to 4-cm right intercostal access, transthoracic aortic occlusion, and peripheral cardiopulmonary bypass. Repairs included 1 or a combination of trapezoidal/triangular leaflet resections, sliding plasties, chordal transfers/replacements, edge-to-edge approximations, and ring annuloplasties. Echocardiographic and survival follow-up were 93% and 100% complete, respectively.
  
  
  RESULTS
  There were 2 (0.7%) 30-day mortalities and 6 (2.0%) late mortalities. No sternotomy conversions or mitral valve replacements were required. Immediate postrepair echocardiograms showed the following degrees of mitral regurgitation: none/trivial, 294 (98%); mild, 3 (1.0%); moderate, 3 (1.0%); and severe, 0 (0.0%). Complications included 2 (0.7%) strokes, 2 transient ischemic attacks, 3 (1.0%) myocardial infarctions, and 7 (2.3%) reoperations for bleeding. The mean hospital stay was 5.2 +/- 4.2 (standard deviation) days. Sixteen (5.3%) patients required a reoperation. Mean postoperative echocardiographic follow-up at 815 +/- 459 (standard deviation) days demonstrated the following degrees of mitral regurgitation: none/trivial, 192 (68.8%); mild, 66 (23.6%); moderate, 15 (5.4%); and severe, 6 (2.2%). Five-year Kaplan-Meier survival was 96.6% +/- 1.5%, with 93.8% +/- 1.6% freedom from reoperation.
  
  
  CONCLUSIONS
  Robotic mitral valve repair is safe and is associated with good midterm durability. Further long-term follow-up is necessary.
authors.affiliation: Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC 27858, USA. chitwoodw@ecu.edu
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
authors.forename: Evelio
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.forename: Ansar
authors.initials: A
authors.lastname: Hassan
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: Paul W
authors.initials: PW
authors.lastname: Vos
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
mesh_terms: D004452:Echocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012371:Robotics; D015996:Survival Rate