title: Robotic mitral valve repairs requiring reoperations.
abstract: OBJECTIVE
  : Robotic mitral valve (MV) repairs are performed at many institutions. Repair failures have been attributed to the challenging technology and potentially to the use of annuloplasty band anchoring U-clips. The purpose of this study was to characterize causes of robotic MV repair failure.
  
  
  METHODS
  : A total of 300 patients underwent a da Vinci robotic MV repair between May 2000 and November 2006 by a single operating console surgeon. Standard repair techniques and a Cosgrove annuloplasty band were used in every case. Clinical data in patients requiring a reoperation, as well as videos of their original operation, were reviewed. MV pathology, repair methods, and findings at reoperation were determined.
  
  
  RESULTS
  : Sixteen (5.3%) patients required reoperation. Seven (7%) failures occurred in the first 100 cases and 9 (4.5%) in the last 200 cases. Initial MV pathology included isolated anterior (n = 4) or posterior leaflet prolapse (n = 6), bileaflet prolapse (n = 3), and annular dilation (n = 3). Reoperations after their initial operation were required early (<6 months) in 8 patients and later in 8 patients. Reasons for reoperation included CHF (n = 9), hemolysis (n = 4), systolic anterior leaflet motion (n = 2), and endocarditis (n = 1). At reoperation, 7 patients had partial dehiscence of the annuloplasty band. The incidence of band dehiscence was not associated with the use of U-clips and decreased with experience.
  
  
  CONCLUSIONS
  : Reoperative rates seemed to decrease with increased case volume and surgeon's experience. Repair results using robotic techniques are similar to conventional techniques. The use of U-clips is not associated with a higher reoperation rate.
authors.affiliation: From the Department of Cardiovascular Medicine, East Carolina Heart Institute, Greenville, NC.
authors.forename: Evelio
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.forename: John
authors.initials: J
authors.lastname: Narron
authors.forename: Karen
authors.initials: K
authors.lastname: Gersch
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood