title: Concomitant robotic mitral and tricuspid valve repair: technique and early experience.
abstract: BACKGROUND
  Robotic mitral valve repair has been successfully performed since the late 1990s, but concomitant robotic tricuspid repair has not yet been widely adopted. We report our first 5 years' experience with concomitant robotic mitral-tricuspid valve repair.
  
  
  METHODS
  Records were reviewed for all patients who underwent concomitant robotic mitral-tricuspid valve repair in a single practice. Cardiopulmonary bypass was performed with femoral cannulation, antegrade and retrograde cardioplegia, and aortic cross-clamping by balloon occlusion. Access was through 5 ports. Tricuspid repair techniques included De Vega, modified De Vega with annuloplasty band, and annuloplasty band with interrupted suture repair.
  
  
  RESULTS
  From August 2006 to December 2011, 50 patients underwent concomitant robotic mitral-tricuspid valve repair. The mean age was 73.4±9.3 years, and all patients had mitral or tricuspid regurgitation grades of 2+ or greater preoperatively. Cross-clamp and cardiopulmonary bypass times decreased significantly with surgeon experience. There were no conversions to sternotomy and one conversion to mitral valve replacement. Six patients required reexploration for bleeding or hemothorax, most of them early in the series. There were no infections, no intraoperative strokes, and no new-onset acute renal failure requiring dialysis. Two postoperative strokes resolved completely. Two patients experienced nitinol clip fracture and mitral ring dehiscence requiring reoperation. There were 2 early deaths. All patients had regurgitation grades of less than 2 at follow-up (p < 0.001).
  
  
  CONCLUSIONS
  Combined robotic mitral-tricuspid valve repair can be performed safely and reproducibly, with acceptable early results. Long-term follow-up will be needed to establish this as an alternative to traditional sternotomy approaches.
authors.affiliation: Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, Alabama. Electronic address: cliftonlewis1942@gmail.com.
authors.forename: Clifton T P
authors.initials: CT
authors.lastname: Lewis
authors.affiliation: Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, Alabama.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Stephens
authors.affiliation: Division of Cardiovascular Perfusion, University of Alabama at Birmingham (UAB) Hospitals, Birmingham, Alabama.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Tyndal
authors.affiliation: Department of Surgery, Sarasota Memorial Hospital, Sarasota, Florida; Sarasota Vascular Specialists, Sarasota, Florida.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cline
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000601:surgery*