title: Multicenter mitral valve study: a lateral approach using the da vinci surgical system.
abstract: OBJECTIVE
  : The purpose of this study was to demonstrate the feasibility of simple to complex endoscopic robotic mitral valve repair, using a lateral approach.
  
  
  METHODS
  : Data were retrospectively collected on 201 patients undergoing a lateral "ports only" endoscopic robotic mitral valve repair at three institutions. Techniques of aortic occlusion included the endoaortic balloon or a transthoracic clamp. The efficacy of the repair was measured intraoperatively by transesophageal echocardiogram.
  
  
  RESULTS
  : Two hundred one patients with a mean age of 55.2 ± 14.2 were intended to undergo elective robotic mitral valve surgery. One hundred eighty-six (92.5%) were scheduled for a repair procedure and 15 (7.5%) were scheduled for replacement. The repair was accomplished in 179 of 186 (96.2%) of patients. Eight patients (4.3%) required a conversion to sternotomy incision. Seven converted patients received a mitral valve repair and one received a replacement mitral valve. Mitral valve pathology included 10% isolated anterior leaflet involvement, 43% isolated posterior leaflet involvement, and 6% bileaflet pathology, and the remaining patients had dilated annulus, chordal rupture, or elongation. One hundred seventy-nine patients (96.2%) had regurgitation grade of 0 to 1 after repair. Two patients (1%) died. Other adverse events included reoperation for valve-related complications, 2 of 201 (1%); reoperation for cardiac-related complications, 3 of 201 (1.5%); and new onset of atrial fibrillation, 35 of 201 (17.4%).
  
  
  CONCLUSIONS
  : A lateral endoscopic robotic approach to mitral valve repair is safe, feasible, and can be performed consistently with acceptable postoperative results. Further follow-up is required to determine the long-term efficacy of this approach to robotic mitral valve repair.
authors.affiliation: From *St. Joseph Hospital, Atlanta, GA; the †Department of Surgery, Good Samaritan Hospital, Cincinnati, OH; ‡Cardiac, Vascular, and Thoracic Surgeons, Inc, Cincinnati, OH; §Sacred Heart Medical, Spokane, WA; ‖Intuitive Surgical, Sunnyvale, CA; and ¶E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, OH.
authors.forename: Douglas
authors.initials: D
authors.lastname: Murphy
authors.forename: J Michael
authors.initials: JM
authors.lastname: Smith
authors.forename: Leland
authors.initials: L
authors.lastname: Siwek
authors.forename: David A
authors.initials: DA
authors.lastname: Langford
authors.forename: John R
authors.initials: JR
authors.lastname: Robinson
authors.forename: Branden
authors.initials: B
authors.lastname: Reynolds
authors.forename: Usha
authors.initials: U
authors.lastname: Seshadri-Kreaden
authors.forename: Amy M
authors.initials: AM
authors.lastname: Engel