title: Robotic mitral valve replacement for severe rheumatic mitral disease: perioperative technique, outcomes, and early results.
abstract: OBJECTIVE
  We report a case series of robotic mitral valve replacement in patients with severe rheumatic mitral disease.
  
  
  METHODS
  From March 2010 to June 2013, a total of 63 patients underwent robotic cardiac procedures. Robotic procedures were performed using the da Vinci Si surgical systems (Intuitive Surgical, Inc, Sunnyvale, CA USA). Eighteen of the patients (28.5%) underwent robotic mitral valve replacement. Rheumatic disease was the underlying pathology in all patients. The mean (SD) follow-up period was 18 (10) months.
  
  
  RESULTS
  The mean (SD) age and EuroSCORE of the patients were 51.2 (11) years and 4.1% (4%), respectively. Seven patients (38.8%) had an additional cardiac procedure. No operative and hospital mortality were observed. The mean (SD) cross-clamp time and cardiopulmonary bypass time were 116 (30) and 178 (54) minutes, the mean (SD) drainage was 430 (350) mL, the mean intubation time was 9.4 (7) hours, the rate of patients extubated within 6 hours or less was 94.4%, and the mean (SD) intensive care unit stay time was 30 (12) hours. Sixteen of the patients (88.8%) were discharged from the intensive care unit within the first 24 hours postoperatively. During the intensive care unit stay, one patient (5.5%) needed inotropic support. There was one early reoperation for bleeding (5.5%), one (5.5%) intensive care unit readmission, and one (5.5%) hospital readmission observed. During the midterm follow-up, there was no mortality and no need for reoperation or reintervention.
  
  
  CONCLUSIONS
  Robotic mitral valve replacement for severe rheumatic mitral disease is technically feasible. Early results are encouraging. Patient selection criteria for robotic mitral valve surgery may be expanded to include valve replacements.
authors.affiliation: From the *Department of Cardiovascular Surgery, Acibadem University School of Medicine; and Departments of †Anesthesiology and Reanimation, ‡Cardiology, and §Nursery, Acibadem Maslak Hospital, Istanbul, Turkey.
authors.forename: Sahin
authors.initials: S
authors.lastname: Senay
authors.forename: Ahmet Umit
authors.initials: AU
authors.lastname: Gullu
authors.forename: Muharrem
authors.initials: M
authors.lastname: Kocyigit
authors.forename: Aleks
authors.initials: A
authors.lastname: Degirmencioglu
authors.forename: Leyla
authors.initials: L
authors.lastname: Kilic
authors.forename: Hasan
authors.initials: H
authors.lastname: Karabulut
authors.forename: Cem
authors.initials: C
authors.lastname: Alhan
mesh_terms: D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012214:Rheumatic Heart Disease / Q000150:complications / Q000601:surgery*; D065287:Robotic Surgical Procedures; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome